Provider Demographics
NPI:1386349652
Name:RODRIGUEZ SIERRA, EFRAIN JESUS
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:JESUS
Last Name:RODRIGUEZ SIERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 7 E9 PASEO MAYOR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-908-8188
Mailing Address - Fax:
Practice Address - Street 1:9WWG H5P, PASEO DR. JOSE CELSO BARBOSA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR65060981835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile Preparations
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program