Provider Demographics
NPI:1497746242
Name:RODRIGUEZ-PORTELA, JAIME L (PHYSICIAN)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:RODRIGUEZ-PORTELA
Suffix:
Gender:M
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 CALLE ARRAYADO
Mailing Address - Street 2:SAN DEMETRIO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3512
Mailing Address - Country:US
Mailing Address - Phone:787-210-8127
Mailing Address - Fax:
Practice Address - Street 1:780 CALLE ARRAYADOSANDEMTRIO
Practice Address - Street 2:HOSPITAL WILMA N VAZQUEZ CARR 2 KM 39.5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3512
Practice Address - Country:US
Practice Address - Phone:787-210-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14001208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice