Provider Demographics
NPI:1528009099
Name:RODRIGUEZ-ROSA, JOSE ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:RODRIGUEZ-ROSA
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:HC 56 BOX 4960
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-8668
Mailing Address - Country:US
Mailing Address - Phone:787-462-0691
Mailing Address - Fax:787-926-0668
Practice Address - Street 1:1486 AVE EMERITO ESTRADA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3047
Practice Address - Country:US
Practice Address - Phone:787-926-0668
Practice Address - Fax:787-926-0668
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10108208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1619323201OtherNPI
PRFE491AOtherPTAN