Provider Demographics
NPI:1770688509
Name:RODRIGUEZ RIVAS, RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:RODRIGUEZ RIVAS
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 501
Mailing Address - Street 2:COTO LAUREL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0501
Mailing Address - Country:US
Mailing Address - Phone:787-432-7193
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:PR 506 STREET KM 1.0
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:UM
Practice Address - Phone:787-432-7193
Practice Address - Fax:787-848-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4292208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0095720Medicare ID - Type Unspecified