MEDICARE: DR. HEIDY M RODRIGUEZ HERNANDEZ MD

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	2085R0202X	Diagnostic Radiology Physician	16290	PR

General Provider Information

NPI Number	:	1760402747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDY M RODRIGUEZ HERNANDEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 362422
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-2422
Country	:	US
Telephone Number	:	787-398-8716
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 CALLE SAN JORGE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3239
Country	:	US
Telephone Number	:	787-398-8716
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	12/03/2018

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