Provider Demographics
NPI:1639169204
Name:RODRIGUEZ-ESCUDERO, JOSE AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:AUGUSTO
Last Name:RODRIGUEZ-ESCUDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1418 CALLE WILSON
Mailing Address - Street 2:APT. #702
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2280
Mailing Address - Country:US
Mailing Address - Phone:787-724-3216
Mailing Address - Fax:787-723-5015
Practice Address - Street 1:1492 PONCE DE LEON, EDIFICIO CENTRO EUROPA
Practice Address - Street 2:SUITE #717
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-5017
Practice Address - Fax:787-723-5015
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR13813207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR141316Medicare UPIN
PR23313Medicare ID - Type Unspecified