Provider Demographics
NPI:1194856377
Name:RODRIGUEZ, CRISTOBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:
Last Name: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:PALACIOS DEL RIO II BLANCO ST. I-2
Mailing Address - Street 2:BOX 664
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-999-4844
Mailing Address - Fax:
Practice Address - Street 1:255 AVE PONCE DE LEON MCS PLAZA PMB#154
Practice Address - Street 2:SUITE 75
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-1919
Practice Address - Country:US
Practice Address - Phone:787-758-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15137208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice