Provider Demographics
NPI:1972535938
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:PO BOX 140151
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0151
Mailing Address - Country:US
Mailing Address - Phone:787-880-5533
Mailing Address - Fax:787-880-5544
Practice Address - Street 1:HOSPITAL CAYETANO COLL Y TOSTE
Practice Address - Street 2:CARRETERA #129, SUITE#110
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614-0151
Practice Address - Country:US
Practice Address - Phone:787-880-5533
Practice Address - Fax:787-880-5544
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG02903Medicare UPIN
PR0089772Medicare PIN