Provider Demographics
NPI:1467893842
Name:RODRIGUEZ-MEDINA, JOSE M (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:RODRIGUEZ-MEDINA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:MANUEL
Other - Last Name:RODRIGUEZ MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 366527
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6527
Mailing Address - Country:US
Mailing Address - Phone:787-765-7320
Mailing Address - Fax:
Practice Address - Street 1:300 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-765-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR21285207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program