Healthcare Provider Details

I. General information

NPI: 1023190071
Provider Name (Legal Business Name): JEPHTE RODRIGUEZ MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DE DIEGO E # 54
MAYAGUEZ PR
00680-4866
US

IV. Provider business mailing address

CALLE DE DIEGO E # 54
MAYAGUEZ PR
00680-4866
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-6599
  • Fax: 787-832-6599
Mailing address:
  • Phone: 787-832-6599
  • Fax: 787-832-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13752
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: