Healthcare Provider Details

I. General information

NPI: 1770519662
Provider Name (Legal Business Name): JOSE ANTONIO RODRIGUEZ MD,PSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 01/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1592 CALLE GUADIANA EL CEREZAL
SAN JUAN PR
00926-3012
US

IV. Provider business mailing address

PO BOX 195163 SAN JUAN
SAN JUAN PR
00919-5163
US

V. Phone/Fax

Practice location:
  • Phone: 787-249-4213
  • Fax: 787-798-9116
Mailing address:
  • Phone: 787-249-4213
  • Fax: 787-798-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number12421
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12421
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12421
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: