Healthcare Provider Details

I. General information

NPI: 1013914019
Provider Name (Legal Business Name): JOSE RAFAEL RODRIGUEZ-SANTANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE TORRE AUXILIO MUTUO SUITE 215
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

PO BOX 8129
CAGUAS PR
00726-8129
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2780
  • Fax: 787-763-6171
Mailing address:
  • Phone: 787-758-2780
  • Fax: 787-763-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number7822
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number7822
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7822
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: