Provider Demographics
NPI:1124169214
Name:SOSA RODRIGUEZ, CARLOS J (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:SOSA RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:J
Other - Last Name:SOSA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:MIGRANT HEALTH CENTER, INC.
Mailing Address - Street 2:P O BOX 7128
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7128
Mailing Address - Country:US
Mailing Address - Phone:787-805-2900
Mailing Address - Fax:787-834-1924
Practice Address - Street 1:MIGRANT HEALTH CENTER, INC
Practice Address - Street 2:CARR 119 KM 35.2 BO PIEDRAS BLANCAS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1665
Practice Address - Fax:787-896-4570
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15021208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22979Medicare ID - Type UnspecifiedMEDICARE
PRI26557Medicare UPIN