Healthcare Provider Details

I. General information

NPI: 1861697971
Provider Name (Legal Business Name): ROBERTO RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. EL JIBARO CARR. 172 KM 13.5 BO. BAYAMON
CIDRA PR
00739
US

IV. Provider business mailing address

PO BOX 9512
CAGUAS PR
00726-9512
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax:
Mailing address:
  • Phone: 787-244-3161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16952
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: