Healthcare Provider Details

I. General information

NPI: 1619323201
Provider Name (Legal Business Name): DR. JOSE E. RODRIGUEZ ROSA PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/19/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1486 AVE EMERITO ESTRADA RIVERA
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

HC 56 BOX 4960
AGUADA PR
00602-8668
US

V. Phone/Fax

Practice location:
  • Phone: 787-926-0668
  • Fax: 787-926-0668
Mailing address:
  • Phone: 787-926-0668
  • Fax: 787-926-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10108
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE ENRIQUE RODRIGUEZ ROSA
Title or Position: DOCTOR
Credential:
Phone: 787-926-0668