Provider Demographics
NPI:1306830542
Name:RODRIGUEZ, HECTOR IVAN (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:IVAN
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 1437
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1437
Mailing Address - Country:US
Mailing Address - Phone:787-735-7818
Mailing Address - Fax:787-735-1165
Practice Address - Street 1:209 CALLE JULIO CINTRON
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3310
Practice Address - Country:US
Practice Address - Phone:787-735-7818
Practice Address - Fax:787-735-1165
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7468OtherDOCTOR IN MEDICINE LICENSE