Provider Demographics
NPI:1366551418
Name:RODRIGUEZ MONGE, STEVEN JUSTINO (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JUSTINO
Last Name:RODRIGUEZ MONGE
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:PO POX 9450
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9450
Mailing Address - Country:US
Mailing Address - Phone:787-743-8305
Mailing Address - Fax:787-961-0000
Practice Address - Street 1:500 AVE. DEGETAU
Practice Address - Street 2:SUITE 511 HIMA PLAZA 1
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-7309
Practice Address - Country:US
Practice Address - Phone:787-743-8305
Practice Address - Fax:787-743-8305
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
212337OtherPREFERRED HEALTH PLAN
2773OtherPREFERRED MEDICAL CHOICE
9250049OtherHUMANA
PE3732OtherPAN AMERICAN LIFE INSURAN
069975OtherCRUZ AZUL DE PR
N683OtherFIRST MEDICAL
N683OtherFIRST MEDICAL
212337OtherPREFERRED HEALTH PLAN
400246Medicare ID - Type UnspecifiedY MUCHO MAS