Provider Demographics
NPI:1225093701
Name:RODRIGUEZ, JOHNNY ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:ARTURO
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:PO BOX 191289
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-771-9639
Mailing Address - Fax:787-762-3433
Practice Address - Street 1:400 DOMENECH AVE
Practice Address - Street 2:SUITE 207, LAS AMERICAS PROFESIONAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-771-9639
Practice Address - Fax:787-762-3433
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27982Medicare UPIN
0020325Medicare ID - Type Unspecified