Provider Demographics
NPI:1427898634
Name:RODRIGUEZ, FERNANDO LUIS
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:RODRIGUEZ
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 1:414 CALLE DAGUAO APT 804
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7858
Mailing Address - Country:US
Mailing Address - Phone:787-593-9557
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO MONTECENTRO
Practice Address - Street 2:APARTMENT H201
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-593-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver