Healthcare Provider Details

I. General information

NPI: 1205801297
Provider Name (Legal Business Name): AGUSTIN ANTONIO RODRIGUEZ GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 AVE MUNOZ RIVERA FIRSTBANK, SUITE 403
RIO PIEDRAS PR
00927-5015
US

IV. Provider business mailing address

PO BOX 364683
SAN JUAN PR
00936-4683
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-1630
  • Fax: 787-756-6957
Mailing address:
  • Phone: 787-756-8562
  • Fax: 787-763-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number11986
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: