Provider Demographics
NPI:1801243571
Name:GRUPO MEDICO DR RODRIGUEZ BLANCO PSC
Entity type:Organization
Organization Name:GRUPO MEDICO DR RODRIGUEZ BLANCO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:RODRIGUEZ CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-463-9065
Mailing Address - Street 1:269 CALLE TRINITARIA
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2217
Mailing Address - Country:US
Mailing Address - Phone:787-463-9065
Mailing Address - Fax:
Practice Address - Street 1:AA3 AVE DON PELAYO
Practice Address - Street 2:URB HACIENDA DEL NORTE
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-5388
Practice Address - Country:US
Practice Address - Phone:787-963-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service