Provider Demographics
NPI:1194818336
Name:RODRIGUEZ, HARRY
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 CARR 2 PMB 272
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BAYAMIN
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-883-6756
Mailing Address - Fax:
Practice Address - Street 1:C TEODOMIRO RAMIREZ 33
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-6756
Practice Address - Fax:787-883-6756
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C741747Medicare UPIN
82115Medicare ID - Type Unspecified