Healthcare Provider Details

I. General information

NPI: 1114916905
Provider Name (Legal Business Name): JAIME OSVALDO RODRIGUEZ-ARIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1484 PASEO FAGOT
PONCE PR
00716-2303
US

IV. Provider business mailing address

1484 PASEO FAGOT
PONCE PR
00716-2303
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-4460
  • Fax: 787-840-4069
Mailing address:
  • Phone: 787-840-4460
  • Fax: 787-840-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number6312
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: