Provider Demographics
NPI:1760150064
Name:RODRIGUEZ, JOSE A
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARRETERA 2 CRUCE DAVILA
Mailing Address - Street 2:URB REPARTO JULIO
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-557-3730
Mailing Address - Fax:
Practice Address - Street 1:CARR 140 URB REPARTO JULIO
Practice Address - Street 2:VACLLE VEGA A4
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-0061
Practice Address - Country:US
Practice Address - Phone:787-557-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty