Provider Demographics
NPI:1265259121
Name:RODRIGUEZ, JUAN J (PA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:COND PASEO GALES
Mailing Address - Street 2:APTD 47 CARR 9189
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-391-0762
Mailing Address - Fax:
Practice Address - Street 1:COND PASEO GALES
Practice Address - Street 2:APTD 47 CARR 9189
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-391-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2311-PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical