Healthcare Provider Details

I. General information

NPI: 1366176810
Provider Name (Legal Business Name): DR. DIEGO RODES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO STE 810
PONCE PR
00716-4725
US

IV. Provider business mailing address

PO BOX 3171
MAYAGUEZ PR
00681-3171
US

V. Phone/Fax

Practice location:
  • Phone: 787-219-9032
  • Fax:
Mailing address:
  • Phone: 787-219-9032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1859554
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number003469
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: