Provider Demographics
NPI:1164005955
Name:PORCIUNCULA JACOBUCCI, RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:PORCIUNCULA JACOBUCCI
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 1:6550 FANNIN ST # SM1661
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-363-9604
Mailing Address - Fax:713-791-5126
Practice Address - Street 1:6550 FANNIN ST # SM1661
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-363-9604
Practice Address - Fax:713-791-5126
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program