Provider Demographics
NPI:1336216639
Name:RODRIGUEZ, NELSON (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
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 88
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0088
Mailing Address - Country:US
Mailing Address - Phone:787-264-3000
Mailing Address - Fax:787-892-5994
Practice Address - Street 1:EDIFICIO PLAZA METROPOLITANA
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0000
Practice Address - Country:US
Practice Address - Phone:787-264-3000
Practice Address - Fax:787-892-5994
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8633207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
83315OtherSSS
582554429OtherAARP
060510OtherCA
310754OtherCIGNA
88794AMedicare ID - Type Unspecified
310754OtherCIGNA