Provider Demographics
NPI:1306805619
Name:ROSA RODRIGUEZ, JOSE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:ROSA RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:CALLE EUCALIPTO I-20
Mailing Address - Street 2:URB ARBOLADA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-852-0505
Mailing Address - Fax:787-850-4230
Practice Address - Street 1:CALLE EUCALIPTO I-20
Practice Address - Street 2:URB ARBOLADA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-852-0505
Practice Address - Fax:787-850-4230
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5364208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0025243Medicare PIN