Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 11557 | PR |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 11557 | PR |
NPI | 1912076761 |
---|---|
Provider Name | Wilfredo Rodriguez |
First Address | Guaynabo, PR 00969-3940 |
Second Address | Guaynabo, PR 00969-3940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 30/03/2017 |