1598859647 NPI number — DR. PORFIRIO RODRIGUEZ MD

Table of content: DR. PORFIRIO RODRIGUEZ MD (NPI 1598859647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598859647 NPI number — DR. PORFIRIO RODRIGUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
PORFIRIO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598859647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11782
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-727-4120
Provider Business Mailing Address Fax Number:
787-268-4054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MANUEL PAVIA 655
Provider Second Line Business Practice Location Address:
EDIF CHINEA OFIC 102
Provider Business Practice Location Address City Name:
SENTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-727-4120
Provider Business Practice Location Address Fax Number:
787-268-4054
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  10615 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 038976000 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 069468 . This is a "LA CRUZ QZUL" identifier . This identifiers is of the category "OTHER".




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