Provider Demographics
NPI:1417634239
Name:RODRIGUEZ SANCHEZ, JORGE E (PA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:RODRIGUEZ SANCHEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 TROPICAL OASIS AVE
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5963
Mailing Address - Country:US
Mailing Address - Phone:787-904-9773
Mailing Address - Fax:
Practice Address - Street 1:4B CALLE EUGENIO M DE HOSTOS
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-2530
Practice Address - Country:US
Practice Address - Phone:787-913-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1752-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant