1619910122 NPI number — DR. JESUS RODRIGUEZ M.D.,F.A.C.O.G,F.A.C

Table of content: DR. JESUS RODRIGUEZ M.D.,F.A.C.O.G,F.A.C (NPI 1619910122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619910122 NPI number — DR. JESUS RODRIGUEZ M.D.,F.A.C.O.G,F.A.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
JESUS
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,F.A.C.O.G,F.A.C
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:
1619910122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 194557
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:
00919-4557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-250-0276
Provider Business Mailing Address Fax Number:
787-756-5618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 CALLE LOS MIRTOS
Provider Second Line Business Practice Location Address:
HYDE PARK
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00927-4236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-250-0276
Provider Business Practice Location Address Fax Number:
787-756-5618
Provider Enumeration Date:
06/13/2006

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: 174400000X , with the licence number:  4291 , 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)





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