Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D0932 | PR |
NPI | 1013024553 |
---|---|
Provider Name | Dr. Jorge L. Rodriguez-Barroso |
First Address | Bayamon, PR 00960-0129 |
Second Address | Bayamon, PR 00956-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |