1619910122 NPI number — JESUS RODRIGUEZ M.D.,F.A.C.O.G,F.A.C

NPI Number: 1619910122
Health Care Provider/Practitioner: JESUS RODRIGUEZ M.D.,F.A.C.O.G,F.A.C

NPI Number : 1619910122 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619910122",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "X",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RODRIGUEZ",
    "FirstName": "JESUS",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.,F.A.C.O.G,F.A.C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 194557",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN JUAN",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00919-4557",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "787-250-0276",
    "MailingAddressFaxNumber": "787-756-5618",
    "FirstLinePracticeLocationAddress": "158 CALLE LOS MIRTOS",
    "SecondLinePracticeLocationAddress": "HYDE PARK",
    "PracticeLocationAddressCityName": "SAN JUAN",
    "PracticeLocationAddressStateName": "PR",
    "PracticeLocationAddressPostalCode": "00927-4236",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "787-250-0276",
    "PracticeLocationAddressFaxNumber": "787-756-5618",
    "EnumerationDate": "06/13/2006",
    "LastUpdateDate": "07/09/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "4291",
        "LicenseNumberStateCode": "PR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}