Provider Demographics
NPI:1255715975
Name:NINO NUNEZ, RODRIGO
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:NINO NUNEZ
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 1:14 CALLE BALDORIOTY APT 202
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3506
Mailing Address - Country:US
Mailing Address - Phone:787-421-5594
Mailing Address - Fax:
Practice Address - Street 1:150 BO MONACILLO AMERICO MIRANDA AVE
Practice Address - Street 2:AREA DE CENTRO MEDICO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-421-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8369246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080026208104Medicaid