Provider Demographics
NPI:1629685953
Name:RODRIGUEZ, CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
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 1:1396 CALLE SAN RAFAEL
Mailing Address - Street 2:MEDICAL PAVILION, SUITE 5
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-725-6713
Mailing Address - Fax:787-998-6733
Practice Address - Street 1:1396 CALLE SAN RAFAEL
Practice Address - Street 2:MEDICAL PAVILION, SUITE 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-725-6713
Practice Address - Fax:787-998-6733
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR21995208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038331200Medicaid