Healthcare Provider Details

I. General information

NPI: 1740288497
Provider Name (Legal Business Name): PABLO E. RODRIGUEZ-RYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 CALLE JILGUERO URB. MONTEHIEDRA
SAN JUAN PR
00926-7109
US

IV. Provider business mailing address

PO BOX 193215
SAN JUAN PR
00919-3215
US

V. Phone/Fax

Practice location:
  • Phone: 787-433-9146
  • Fax: 787-789-7457
Mailing address:
  • Phone: 787-433-9146
  • Fax: 787-789-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4995
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: