Healthcare Provider Details

I. General information

NPI: 1114010147
Provider Name (Legal Business Name): ANIBAL A RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ROSSI ESQ DEGETAU
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 51036 LEVITTOWN STATION
TOA BAJA PR
00950
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-4259
  • Fax: 787-269-5230
Mailing address:
  • Phone: 787-640-3815
  • Fax: 787-269-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12636
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: