Provider Demographics
NPI:1295843837
Name:RODRIGUEZ, JOSUE BAUTISTA (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSUE
Middle Name:BAUTISTA
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 AVE PONCE DE LEON
Mailing Address - Street 2:APT# 705
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1851
Mailing Address - Country:US
Mailing Address - Phone:787-671-9555
Mailing Address - Fax:787-721-5869
Practice Address - Street 1:146 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1919
Practice Address - Country:US
Practice Address - Phone:787-722-5422
Practice Address - Fax:787-721-5869
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor