Provider Demographics
NPI:1770519662
Name:RODRIGUEZ, JOSE ANTONIO (MD,PSC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD,PSC
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Mailing Address - Street 1:PO BOX 195163
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5163
Mailing Address - Country:US
Mailing Address - Phone:787-249-4213
Mailing Address - Fax:787-798-9116
Practice Address - Street 1:1592 CALLE GUADIANA
Practice Address - Street 2:EL CEREZAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3012
Practice Address - Country:US
Practice Address - Phone:787-249-4213
Practice Address - Fax:787-798-9116
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2017-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR12421207UN0902X, 2084N0400X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89050Medicare ID - Type Unspecified
PR0THO000Medicare UPIN