Provider Demographics
NPI:1013319995
Name:RODRIGUEZ LEON, JOSE VALENTIN
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:VALENTIN
Last Name:RODRIGUEZ LEON
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:URB PONCE DE LEON #180 CALLE 22
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00969
Mailing Address - Country:UM
Mailing Address - Phone:787-233-3930
Mailing Address - Fax:
Practice Address - Street 1:300 DOMENECH AVE.
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00918
Practice Address - Country:UM
Practice Address - Phone:787-765-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR21004207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program