Provider Demographics
NPI:1598859647
Name:RODRIGUEZ, PORFIRIO (MD)
Entity Type:Individual
Prefix:DR
First Name:PORFIRIO
Middle Name:
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 11782
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-727-4120
Mailing Address - Fax:787-268-4054
Practice Address - Street 1:MANUEL PAVIA 655
Practice Address - Street 2:EDIF CHINEA OFIC 102
Practice Address - City:SENTURCE
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-727-4120
Practice Address - Fax:787-268-4054
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038976000Medicaid
069468OtherLA CRUZ QZUL
F27967Medicare UPIN