Provider Demographics
NPI:1740288497
Name:RODRIGUEZ-RYAN, PABLO E (MD)
Entity type:Individual
Prefix:DR
First Name:PABLO
Middle Name:E
Last Name:RODRIGUEZ-RYAN
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 193215
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3215
Mailing Address - Country:US
Mailing Address - Phone:787-433-9146
Mailing Address - Fax:787-789-7457
Practice Address - Street 1:287 CALLE JILGUERO
Practice Address - Street 2:URB. MONTEHIEDRA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7109
Practice Address - Country:US
Practice Address - Phone:787-433-9146
Practice Address - Fax:787-789-7457
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4995208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
0097534Medicare ID - Type Unspecified
D08724Medicare UPIN