Provider Demographics
NPI:1154188795
Name:RODRIGUEZ, MANUEL ANTONIO (RN)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLINAS DEL MARQUES
Mailing Address - Street 2:D 26 CLL MERCED
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:939-400-4346
Mailing Address - Fax:
Practice Address - Street 1:864
Practice Address - Street 2:44D
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0069
Practice Address - Country:US
Practice Address - Phone:939-400-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse