Provider Demographics
NPI:1649214776
Name:DR.JESUS W RODRIGUEZ,PSC
Entity Type:Organization
Organization Name:DR.JESUS W RODRIGUEZ,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:W
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-3939
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0664
Mailing Address - Country:US
Mailing Address - Phone:787-812-3939
Mailing Address - Fax:787-812-3931
Practice Address - Street 1:CARRETERA 132 KM 22.1BO CANAS
Practice Address - Street 2:PLAZA GABRIELA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-812-3939
Practice Address - Fax:787-812-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85070DROtherTRIPLE S