Healthcare Provider Details

I. General information

NPI: 1497746242
Provider Name (Legal Business Name): JAIME L. RODRIGUEZ-PORTELA PHYSICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 CALLE ARRAYADOSANDEMTRIO HOSPITAL WILMA N VAZQUEZ CARR 2 KM 39.5
VEGA BAJA PR
00693-3512
US

IV. Provider business mailing address

780 CALLE ARRAYADO SAN DEMETRIO
VEGA BAJA PR
00693-3512
US

V. Phone/Fax

Practice location:
  • Phone: 787-210-8127
  • Fax:
Mailing address:
  • Phone: 787-210-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14001
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: