Provider Demographics
NPI:1396727541
Name:RODRIGUEZ, HARRY LOPEZ (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:LOPEZ
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:HC 3 BOX 5619
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9504
Mailing Address - Country:US
Mailing Address - Phone:787-852-4743
Mailing Address - Fax:787-852-5292
Practice Address - Street 1:CARRETERA 924 KM 2. 7
Practice Address - Street 2:BO PITAHAYA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-4743
Practice Address - Fax:787-852-5292
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0027492Medicare ID - Type Unspecified
C79667Medicare UPIN