Provider Demographics
NPI:1720393135
Name:RODRIGUEZ, MANUEL JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:JOSE
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:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0075
Mailing Address - Country:US
Mailing Address - Phone:787-640-4518
Mailing Address - Fax:
Practice Address - Street 1:63 MENDEZ VIGO E
Practice Address - Street 2:SUITE 3A CONDOMINIO CENTRO PLAZA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4972
Practice Address - Country:US
Practice Address - Phone:787-831-4320
Practice Address - Fax:787-831-4320
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology