Provider Demographics
NPI:1619910122
Name:RODRIGUEZ, JESUS (MD,FACOG,FAC)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD,FACOG,FAC
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 194557
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4557
Mailing Address - Country:US
Mailing Address - Phone:787-250-0276
Mailing Address - Fax:787-756-5618
Practice Address - Street 1:158 CALLE LOS MIRTOS
Practice Address - Street 2:HYDE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4236
Practice Address - Country:US
Practice Address - Phone:787-250-0276
Practice Address - Fax:787-756-5618
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84074Medicare UPIN