1043088446 NPI number — PROF. ANGEL LUIS MARTINEZ RODRIGUEZ MSN-ED CERN

Table of content: PROF. ANGEL LUIS MARTINEZ RODRIGUEZ MSN-ED CERN (NPI 1043088446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043088446 NPI number — PROF. ANGEL LUIS MARTINEZ RODRIGUEZ MSN-ED CERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ RODRIGUEZ
Provider First Name:
ANGEL
Provider Middle Name:
LUIS
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MSN-ED CERN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043088446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAYEY
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00737-0566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-282-0085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URBANIZACION TURABO GARDEN CARRETERA 172 SALIDA 21
Provider Second Line Business Practice Location Address:
ESCUELA DE MEDICINA SAN JUAN BAUTISTA
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-0072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-337-4208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WN0800X , with the licence number:  03882 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC0200X , with the licence number: 03882 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)