Provider Demographics
NPI:1083645162
Name:RODRIGUEZ-BLAZQUEZ, HECTOR M (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:M
Last Name:RODRIGUEZ-BLAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0966
Mailing Address - Country:US
Mailing Address - Phone:787-833-0473
Mailing Address - Fax:787-832-3088
Practice Address - Street 1:14 CALLE DE DIEGO E
Practice Address - Street 2:MEDICO DE DIEGO 101
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4890
Practice Address - Country:US
Practice Address - Phone:787-833-0473
Practice Address - Fax:787-832-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9460208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83652Medicare UPIN
0082453Medicare PIN