Provider Demographics
NPI:1619067170
Name:RODRIGUEZ, ERASTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERASTO
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 1828
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1828
Mailing Address - Country:US
Mailing Address - Phone:787-739-3435
Mailing Address - Fax:787-739-8044
Practice Address - Street 1:140 JOSE DE DIEGO ST
Practice Address - Street 2:ARENAS EXIT
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-9495
Practice Address - Fax:787-739-8044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083368Medicare ID - Type Unspecified
PRF62613Medicare UPIN