Healthcare Provider Details

I. General information

NPI: 1306830542
Provider Name (Legal Business Name): HECTOR IVAN RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CALLE JULIO CINTRON
AIBONITO PR
00705-3310
US

IV. Provider business mailing address

PO BOX 1437
AIBONITO PR
00705-1437
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-7818
  • Fax: 787-735-1165
Mailing address:
  • Phone: 787-735-7818
  • Fax: 787-735-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number7468
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: