Provider Demographics
NPI:1205801297
Name:RODRIGUEZ GONZALEZ, AGUSTIN ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:ANTONIO
Last Name:RODRIGUEZ GONZALEZ
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 364683
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4683
Mailing Address - Country:US
Mailing Address - Phone:787-756-8562
Mailing Address - Fax:787-763-3898
Practice Address - Street 1:1056 AVE MUNOZ RIVERA
Practice Address - Street 2:FIRSTBANK, SUITE 403
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927-5015
Practice Address - Country:US
Practice Address - Phone:787-765-1630
Practice Address - Fax:787-756-6957
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR119862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088623OtherMEDICARE PTAN
PRE19526Medicare UPIN
PR88623ROMedicare ID - Type Unspecified