Provider Demographics
NPI:1174582753
Name:RODRIGUEZ, JESUS MANUEL (RN)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MANUEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8 CALLE MONTE DEL ESTADO
Mailing Address - Street 2:COLINAS METROPOLITANAS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5238
Mailing Address - Country:US
Mailing Address - Phone:787-470-4150
Mailing Address - Fax:
Practice Address - Street 1:W8 CALLE MONTE DEL ESTADO
Practice Address - Street 2:COLINAS METROPOLITANAS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5238
Practice Address - Country:US
Practice Address - Phone:787-470-4150
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012613163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR012613OtherLICENSED REGISTERED NURSE