1205898855 NPI number — DR. PEDRO J RODRIGUEZ BENITEZ M.D.

Table of content: DR. PEDRO J RODRIGUEZ BENITEZ M.D. (NPI 1205898855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205898855 NPI number — DR. PEDRO J RODRIGUEZ BENITEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ BENITEZ
Provider First Name:
PEDRO
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1205898855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00659-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-691-9568
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CENTRO ISABELINO DE MEDICINA AVANZADA
Provider Second Line Business Practice Location Address:
AVE AGUSTIN R CALERO KM 1.1
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-830-2705
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2006

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: 207RC0000X , with the licence number:  8989 , 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: 3889921 . This is a "CIGNA NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 4508989 . This is a "UIA NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 067737 . This is a "CRUZ AZUL NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 81899 . This is a "TRIPLE-S NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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