Provider Demographics
NPI:1306834098
Name:RODRIGUEZ-PERALES, RICARDO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:JAVIER
Last Name:RODRIGUEZ-PERALES
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 195325
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5325
Mailing Address - Country:US
Mailing Address - Phone:787-620-8999
Mailing Address - Fax:787-620-8998
Practice Address - Street 1:ROAD 165 NUM 48 CITY VIEW PLAZA
Practice Address - Street 2:SUITE 321
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-620-8999
Practice Address - Fax:787-620-8998
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10939207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG86404Medicare UPIN