Provider Demographics
NPI:1861773244
Name:SANTOS RODRIGUEZ, MARCOS GERARDO
Entity type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:GERARDO
Last Name:SANTOS 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:PO BOX 371990
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1990
Mailing Address - Country:US
Mailing Address - Phone:787-402-7428
Mailing Address - Fax:
Practice Address - Street 1:CALLE C A-1 REPARTO MONTELLANO
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-1990
Practice Address - Country:US
Practice Address - Phone:787-402-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR117981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical