Healthcare Provider Details

I. General information

NPI: 1548257421
Provider Name (Legal Business Name): MANUEL GONZALEZ-RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 10/06/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 3, KM. 8.3, AVE. 65 DE INFANTERIA HOSPITAL UPR DR. FEDERICO TRILLA
CAROLINA PR
00984
US

IV. Provider business mailing address

PO BOX 8878
CAROLINA PR
00988-8878
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1800
  • Fax: 787-276-2205
Mailing address:
  • Phone: 787-378-6731
  • Fax: 787-768-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number8908
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number8908
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: