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General NPI Number Information
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NPI Number | 1619910122
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Entity Type | Individual
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Provider Name | JESUS RODRIGUEZ M.D.,F.A.C.O.G,F.A.C
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 158 CALLE LOS MIRTOS HYDE PARK
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City | SAN JUAN
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State | PR
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Zip | 00927-4236
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Country | US
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Telephone | 787-250-0276
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Fax | 787-756-5618
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Provider Business Mailing Address
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Address Line | PO BOX 194557
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City | SAN JUAN
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State | PR
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Zip | 00919-4557
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Country | US
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Telephone | 787-250-0276
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Fax | 787-756-5618
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4291
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License Number State | PR
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