MEDICARE: REYNALDO DEJESUS-RODRIGUEZ M.D.

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	207T00000X	Neurological Surgery Physician	13269	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881791663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REYNALDO DEJESUS-RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	909 AVE TITO CASTRO STE 614
Second Line	:	TORRE MEDICA SAN LUCAS
City	:	PONCE
State	:	PR
Zip	:	00716
Country	:	US
Telephone Number	:	787-840-8174
Fax Number	:	787-843-2084

Provider Business Practice Location Address
First Line	:	909 AVE TITO CASTRO STE 614
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716-4722
Country	:	US
Telephone Number	:	787-840-8174
Fax Number	:	787-843-2084

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/18/2024

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Directions to “ REYNALDO DEJESUS-RODRIGUEZ M.D.” Practice Location

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