Healthcare Provider Details

I. General information

NPI: 1487270195
Provider Name (Legal Business Name): MR. JUAN RAFAEL RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36TH MEDICAL GROUP, UNIT 14010 BLDG. 26012 ANDERSEN AFB
APO AP
96543-4003
US

IV. Provider business mailing address

105 KAYON PATNITOS APT 127
DEDEDO GU
96929-7525
US

V. Phone/Fax

Practice location:
  • Phone: 671-366-4721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: