Provider Demographics
NPI:1295964831
Name:ROSARIO RODRIGUEZ, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:ROSARIO 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:A6 CALLE 14
Mailing Address - Street 2:URB VILLA HUMACAO
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4627
Mailing Address - Country:US
Mailing Address - Phone:787-372-0456
Mailing Address - Fax:
Practice Address - Street 1:A6 CALLE 14
Practice Address - Street 2:URB VILLA HUMACAO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4627
Practice Address - Country:US
Practice Address - Phone:787-372-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17633208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice