Provider Demographics
NPI:1063581981
Name:RODRIGUEZ, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CC40 CALLE CEIBAS
Mailing Address - Street 2:RIO HONDO 3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3419
Mailing Address - Country:US
Mailing Address - Phone:787-786-8836
Mailing Address - Fax:
Practice Address - Street 1:HANGAR 21
Practice Address - Street 2:ISLA GRANDE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00902
Practice Address - Country:US
Practice Address - Phone:787-948-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant