Provider Demographics
NPI:1528037876
Name:RODRIGUEZ, JUSTO X (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTO
Middle Name:X
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:PO BOX 2054
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-961-6160
Mailing Address - Fax:787-961-6165
Practice Address - Street 1:CALLE RUIZ BELVIS 47 ESQUINA CALLE CORCHADO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-961-6160
Practice Address - Fax:787-961-6165
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR140002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023039Medicare ID - Type UnspecifiedPSICHIATRY