Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2458 | PR |
NPI | 1013956168 |
---|---|
Provider Name | Dr. Nelson Rodriguez SR. |
First Address | Bayamon, PR 00961-7031 |
Second Address | Bayamon, PR 00961-7031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 10/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91802 | (02) | PR |