Provider Demographics
NPI:1770100836
Name:RODRIGUEZ ACOSTA, EMMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:RODRIGUEZ ACOSTA
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:URB LA RAMBLA
Mailing Address - Street 2:926 CALLE ZARAGOZA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-974-7295
Mailing Address - Fax:
Practice Address - Street 1:URB LA RAMBLA
Practice Address - Street 2:926 CALLE ZARAGOZA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-974-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24160208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice