Provider Demographics
NPI:1023094281
Name:RODRIGUEZ ZAYAS, MANUEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:A
Last Name:RODRIGUEZ ZAYAS
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 9007
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9007
Mailing Address - Country:US
Mailing Address - Phone:787-984-0992
Mailing Address - Fax:787-984-0932
Practice Address - Street 1:3084 AVE EMILIO FAGOT
Practice Address - Street 2:URB SANTA CLARA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4117
Practice Address - Country:US
Practice Address - Phone:787-984-0992
Practice Address - Fax:787-984-0932
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6360174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79703Medicare UPIN