Provider Demographics
NPI:1124019666
Name:MAISONET-RODRIGUEZ, ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:MAISONET-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 135
Mailing Address - Street 2:53 AVE ESMERALDA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4429
Mailing Address - Country:US
Mailing Address - Phone:787-798-0256
Mailing Address - Fax:787-798-0259
Practice Address - Street 1:ATENAS F61
Practice Address - Street 2:EXT FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5605
Practice Address - Country:US
Practice Address - Phone:787-798-0256
Practice Address - Fax:787-798-0259
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9352208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
81935Medicare ID - Type Unspecified
E63414Medicare UPIN