Provider Demographics
NPI:1790748689
Name:OCASIO-RODRIGUEZ, JUAN A (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:A
Last Name:OCASIO-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 281
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-798-6549
Mailing Address - Fax:787-780-9247
Practice Address - Street 1:AVE LOMAS VERDES
Practice Address - Street 2:IF-50 ROYAL PALM
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-6085
Practice Address - Fax:787-780-9247
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5898207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
97839OCMedicare ID - Type Unspecified