Healthcare Provider Details

I. General information

NPI: 1760150064
Provider Name (Legal Business Name): DR. JOSE A RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 140 URB REPARTO JULIO VACLLE VEGA A4
BARCELONETA PR
00617-0061
US

IV. Provider business mailing address

CARRETERA 2 CRUCE DAVILA URB REPARTO JULIO
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-557-3730
  • Fax:
Mailing address:
  • Phone: 787-557-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: