Provider Demographics
NPI:1740217215
Name:RODRIGUEZ BURGOS, PEDRO J (MD)
Entity type:Individual
Prefix:
First Name:PEDRO J
Middle Name:
Last Name:RODRIGUEZ BURGOS
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 1434
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1434
Mailing Address - Country:US
Mailing Address - Phone:787-837-0562
Mailing Address - Fax:787-260-0885
Practice Address - Street 1:TOMAS CARRION MADURO ST #29 ALTOS
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-837-0562
Practice Address - Fax:787-260-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics