Healthcare Provider Details

I. General information

NPI: 1811197809
Provider Name (Legal Business Name): JOSE RODRIGUEZ-GALARZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B31 PAISAJES DEL ESCORIAL
CAROLINA PR
00987-4880
US

IV. Provider business mailing address

85 BLVD MEDIA LUNA APT 206 PAISAJES DEL ESCORIAL
CAROLINA PR
00987-4880
US

V. Phone/Fax

Practice location:
  • Phone: 939-208-9839
  • Fax:
Mailing address:
  • Phone: 939-208-9839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12713
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number12713
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: