Healthcare Provider Details

I. General information

NPI: 1689594855
Provider Name (Legal Business Name): VENEGAS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO
PONCE PR
00716-4728
US

IV. Provider business mailing address

909 AVE TITO CASTRO TORRE SAN LUCAS SUITE 513
PONCE PR
00716-4728
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-0900
  • Fax: 787-841-4246
Mailing address:
  • Phone: 787-259-0900
  • Fax: 787-841-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR MIGUEL RODRIGUEZ-VENEGAS
Title or Position: PROPIETARY
Credential: MD
Phone: 787-645-2052