MEDICARE: DR. SEGUNDO A RODRIGUEZ M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	011740	PR
2	174400000X	Specialist

General Provider Information

NPI Number	:	1417903220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEGUNDO A RODRIGUEZ M.D

Provider Business Mailing Address
First Line	:	611 CALLE PAVIA
Second Line	:	SUITE 110
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2239
Country	:	US
Telephone Number	:	787-727-4737
Fax Number	:	787-727-4714

Provider Business Practice Location Address
First Line	:	611 CALLE PAVIA
Second Line	:	SUITE 110
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2239
Country	:	US
Telephone Number	:	787-727-4737
Fax Number	:	787-727-4714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	10/06/2020

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