MEDICARE: DR. JOSE ANTONIO RODRIGUEZ MD,PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0902X	Nuclear Imaging & Therapy Physician	12421	PR
2	2084N0400X	Neurology Physician	12421	PR
3	208600000X	Surgery Physician	12421	PR

General Provider Information

NPI Number	:	1770519662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ANTONIO RODRIGUEZ MD,PSC

Provider Business Mailing Address
First Line	:	PO BOX 195163
Second Line	:	SAN JUAN
City	:	SAN JUAN
State	:	PR
Zip	:	00919-5163
Country	:	US
Telephone Number	:	787-249-4213
Fax Number	:	787-798-9116

Provider Business Practice Location Address
First Line	:	1592 CALLE GUADIANA
Second Line	:	EL CEREZAL
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3012
Country	:	US
Telephone Number	:	787-249-4213
Fax Number	:	787-798-9116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	01/28/2017

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