Provider Demographics
NPI:1619323201
Name:DR. JOSE E. RODRIGUEZ ROSA PSC
Entity Type:Organization
Organization Name:DR. JOSE E. RODRIGUEZ ROSA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:RODRIGUEZ ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-926-0668
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:787-926-0668
Mailing Address - Fax:787-926-0668
Practice Address - Street 1:1486 AVE EMERITO ESTRADA RIVERA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-926-0668
Practice Address - Fax:787-926-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10108174400000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG67885Medicare UPIN