Provider Demographics
NPI:1235344979
Name:RODRIGUEZ, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
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:SANTA ROSA
Mailing Address - Street 2:40-20 CALLE 22
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6551
Mailing Address - Country:US
Mailing Address - Phone:787-786-4559
Mailing Address - Fax:787-999-0829
Practice Address - Street 1:CALLE 22 URB. SANTA ROSA
Practice Address - Street 2:BLOQUE 40 #20
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-6551
Practice Address - Country:US
Practice Address - Phone:787-786-4559
Practice Address - Fax:787-999-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10036305S00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty