Basic Information
| Provider Information | |||||||||
| NPI: | 1396311171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ-NAZARIO | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | XAVIER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3527 | ||||||||
| Address2: | |||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009703527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873998183 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARR. 22, BO MONACILLOS, CENTRO MEDICO | ||||||||
| Address2: | OFICINA 1-A-35 | ||||||||
| City: | RIO PIEDRAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874740333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 15804 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.