Provider Demographics
NPI:1992767768
Name:RODRIGUEZ QUIJANO, GABRIEL (OD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:RODRIGUEZ QUIJANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2272
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2003
Mailing Address - Country:US
Mailing Address - Phone:787-895-6197
Mailing Address - Fax:
Practice Address - Street 1:ROAD. #2 KM. 96.8 BO. COCOS
Practice Address - Street 2:
Practice Address - City:QUEBADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58015Medicare ID - Type Unspecified
PRT20861Medicare UPIN