Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 908 | PR |
NPI | 1063871457 |
---|---|
Provider Name | Mr. Ramon Rodriguez Maldonado |
First Address | San Juan, PR 00926-4902 |
Second Address | San Juan, PR 00926-4902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2016 |
Last Update Date | 24/12/2021 |