Provider Demographics
NPI:1255433629
Name:RODRIGUEZ PEREZ, VICTOR MANUEL (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
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:FLAMBOYAN S C 12 URB VALLE HERMOSO
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-384-2752
Mailing Address - Fax:
Practice Address - Street 1:CALLE ANGEL M QUINONES
Practice Address - Street 2:POLICLINICA DR MARIN
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-804-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14412208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14412OtherPROFESSIONAL LICENCE