Provider Demographics
NPI:1063871457
Name:RODRIGUEZ MALDONADO, RAMON (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
Last Name:RODRIGUEZ MALDONADO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CALLE ACUARIO
Mailing Address - Street 2:VENUS GARDENS PLAZA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4902
Mailing Address - Country:US
Mailing Address - Phone:939-319-7777
Mailing Address - Fax:
Practice Address - Street 1:19 CALLE ACUARIO
Practice Address - Street 2:VENUS GARDENS PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4902
Practice Address - Country:US
Practice Address - Phone:787-225-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR908156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician