Provider Demographics
NPI:1558327668
Name:RODRIGUEZ, JUAN J (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
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 360-283
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935
Mailing Address - Country:US
Mailing Address - Phone:787-798-4047
Mailing Address - Fax:787-780-3272
Practice Address - Street 1:301 TORRE SAN PABLO
Practice Address - Street 2:SANTA CRUZ ST
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-798-4047
Practice Address - Fax:787-780-3272
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR62712084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31407Medicare UPIN
PR0026091Medicare ID - Type Unspecified