Healthcare Provider Details

I. General information

NPI: 1235661521
Provider Name (Legal Business Name): JOSE ROBERTO RODRIGUEZ VAZQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 RD 2 CT RADIOLOGY COMPLEX IMAGING CENTER
BAYAMON PR
00956
US

IV. Provider business mailing address

1815 RD 2 CT RADIOLOGY COMPLEX IMAGING CENTER
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-9069
  • Fax:
Mailing address:
  • Phone: 787-780-9069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number021324
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number021324
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: