MEDICARE: DR. ISMAEL RODRIGUEZ-RIVERA MD, BC

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	207R00000X	Internal Medicine Physician	11799	PR

General Provider Information

NPI Number	:	1487620340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISMAEL RODRIGUEZ-RIVERA MD, BC

Provider Business Mailing Address
First Line	:	PO BOX 2697
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-2697
Country	:	US
Telephone Number	:	787-785-6506
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 CALLE SANTA CRUZ
Second Line	:	GALERIA MEDICA SUITE 106
City	:	BAYAMON
State	:	PR
Zip	:	00961-7003
Country	:	US
Telephone Number	:	787-785-8600
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	02/26/2021

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