Provider Demographics
NPI:1679840862
Name:MAS RODRIGUEZ, MANUEL FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:FERNANDO
Last Name:MAS 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 1:1511 AVE. PONCE DE LEON
Mailing Address - Street 2:APT. 1125 COND. LA CIUDADELA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-307-7854
Mailing Address - Fax:
Practice Address - Street 1:HIMA SAN PABLO CAGUAS
Practice Address - Street 2:100 AVE LUIS MUNOZ MARIN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0073208100000X
PR13049I390200000X
PR196402081P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
8GA512OtherBCBS
TX512902YKY3OtherMEDICARE