Provider Demographics
NPI:1104812122
Name:RODRIGUEZ FONTANEZ, JOSE JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JAVIER
Last Name:RODRIGUEZ FONTANEZ
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:AVE. PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:BOX 2866
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2866
Mailing Address - Country:US
Mailing Address - Phone:787-864-5953
Mailing Address - Fax:787-864-5953
Practice Address - Street 1:AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-864-5953
Practice Address - Fax:787-864-5953
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6590207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27690Medicare ID - Type Unspecified
PRC-79689Medicare UPIN