Healthcare Provider Details

I. General information

NPI: 1245331339
Provider Name (Legal Business Name): JUAN A RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 1 48 EXT. HERMANAS DAVILA
BAYAMON PR
00959
US

IV. Provider business mailing address

90 CALLE REINA DE LAS FLORES CIUDAD JARDIN 3
TOA ALTA PR
00953-4860
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-4851
  • Fax: 787-785-4851
Mailing address:
  • Phone: 787-785-4851
  • Fax: 787-785-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4369
License Number StatePR

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: