Provider Demographics
NPI:1235235466
Name:RODRIGUEZ, JAIME H (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:H
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:JOSE JULIAN ACOSTA ST
Mailing Address - Street 2:62B
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-855-5336
Mailing Address - Fax:787-855-5336
Practice Address - Street 1:JOSE J ACOSTA ST
Practice Address - Street 2:62B
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-5336
Practice Address - Fax:787-855-5336
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6964FAMILYPHYSICIAN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98573Medicare ID - Type Unspecified
D26720Medicare UPIN