Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 6590 | PR |
NPI | 1104812122 |
---|---|
Provider Name | Dr. Jose Javier Rodriguez Fontanez |
First Address | Guayama, PR 00785-2866 |
Second Address | Guayama, PR 00785 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 11/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C-79689 | (02) | PR |