Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 22204 | PR |
NPI | 1023506268 |
---|---|
Provider Name | Dr. Pedro Eduardo Rodriguez Ortiz |
First Address | Loiza, PR 00772-0509 |
Second Address | Loiza, PR 00772-1850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 12/03/2021 |