Provider Demographics
NPI:1063920585
Name:RODRIGUEZ MARTINEZ, JOSE G (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:RODRIGUEZ MARTINEZ
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 1:11300 CALLE AMAPOLA
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-3135
Mailing Address - Country:US
Mailing Address - Phone:787-238-5587
Mailing Address - Fax:
Practice Address - Street 1:48 CALLE FRANCISCO G BRUNO W
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4734
Practice Address - Country:US
Practice Address - Phone:787-238-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101Y00000X, 251V00000X
PR15974I390200000X
PR23107208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251V00000XAgenciesVoluntary or Charitable
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program