Provider Demographics
NPI:1295701951
Name:RODRIGUEZ, JORGE EFRAIN (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:EFRAIN
Last Name:RODRIGUEZ
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 70344
Mailing Address - Street 2:PMB#91
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-751-0909
Mailing Address - Fax:787-763-5080
Practice Address - Street 1:525 FD ROOSVELT TORRE PLAZA LAS AMERICAS
Practice Address - Street 2:SUITE 707
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-0909
Practice Address - Fax:787-763-5080
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR082591Medicare ID - Type Unspecified
PRG40926Medicare UPIN