Provider Demographics
NPI:1629049341
Name:RODRIGUEZ ROSA, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:RODRIGUEZ ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:
Other - Last Name:RODRIGUEZ ROSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 6432
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-9734
Mailing Address - Country:US
Mailing Address - Phone:787-622-5100
Mailing Address - Fax:787-622-5102
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 702
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-622-5100
Practice Address - Fax:787-622-5102
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13261207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH96098Medicare UPIN