Provider Demographics
NPI:1043021355
Name:NOBLE RODRIGUEZ, FERNANDO LUIS
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:NOBLE 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 1:96 BO DAGUAO
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-2913
Mailing Address - Country:US
Mailing Address - Phone:787-518-7865
Mailing Address - Fax:
Practice Address - Street 1:96 BO DAGUAO
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-2913
Practice Address - Country:US
Practice Address - Phone:787-518-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program