Provider Demographics
NPI:1639143480
Name:RODRIGUEZ PEREZ, FEDERICO (MD)
Entity type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:
Last Name:RODRIGUEZ PEREZ
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 19647
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1647
Mailing Address - Country:US
Mailing Address - Phone:787-919-7865
Mailing Address - Fax:787-919-7868
Practice Address - Street 1:1420 CALLE AMERICO SALAS
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2139
Practice Address - Country:US
Practice Address - Phone:787-919-7865
Practice Address - Fax:787-919-7868
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9101207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F31659Medicare UPIN
830022ROMedicare ID - Type Unspecified