MEDICARE: JOSE M GARCIA RODRIGUEZ

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	390200000X	Student in an Organized Health Care Education/Training Program	17772-I	PR

General Provider Information

NPI Number	:	1952238321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE M GARCIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	426 AVE SAN JOSE E
Second Line	:
City	:	AIBONITO
State	:	PR
Zip	:	00705-3700
Country	:	US
Telephone Number	:	787-519-3186
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 AVE PONCE DE LEON
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-5032
Country	:	US
Telephone Number	:	787-758-2000
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/15/2026

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