Provider Demographics
NPI:1295775419
Name:RODRIGUEZ, EDGARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:
Last Name:RODRIGUEZ
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:A113 CALLE 2
Mailing Address - Street 2:ESTANCIAS DEL LAGO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-743-0985
Mailing Address - Fax:
Practice Address - Street 1:A113 CALLE 2
Practice Address - Street 2:ESTANCIAS DEL LAGO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-743-0985
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6170207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027370Medicare ID - Type Unspecified
PRE43966Medicare UPIN