Provider Demographics
NPI:1407921760
Name:RODRIGUEZ, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
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 1:110 ESMERALDA
Mailing Address - Street 2:CIELO DORADO VILLAGE
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-270-1506
Mailing Address - Fax:787-870-1508
Practice Address - Street 1:PMB SUITE 145
Practice Address - Street 2:AVE. 90 RIO HONDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3113
Practice Address - Country:US
Practice Address - Phone:787-378-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-8088OtherMCS
PR82919-ROOtherTRIPLE-S
PR203302OtherPREFFERED HEALTH
PR7232OtherINTERNATIAL MEDICAL CARD
PR7830002OtherHUMANA INSURANCE
PRM-1915OtherCRUZ AZUL
PR08088OtherSTATE MEDICAL LICENSE