Provider Demographics
NPI:1184606618
Name:RODRIGUEZ-PEREZ, ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:RODRIGUEZ-PEREZ
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 59
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0059
Mailing Address - Country:US
Mailing Address - Phone:787-264-7174
Mailing Address - Fax:787-264-7174
Practice Address - Street 1:100 CALLE HERNAN ALVAREZ
Practice Address - Street 2:PLAZA METROPOLITANA SUITE 202
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4173
Practice Address - Country:US
Practice Address - Phone:787-264-7174
Practice Address - Fax:787-264-7174
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82026Medicare UPIN
89097Medicare ID - Type Unspecified