Provider Demographics
NPI:1316940570
Name:RODRIGUEZ-VEGA, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:RODRIGUEZ-VEGA
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 BOX 70344 PMB 26
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-620-4763
Mailing Address - Fax:787-288-2301
Practice Address - Street 1:70 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7052
Practice Address - Country:US
Practice Address - Phone:787-620-4763
Practice Address - Fax:787-288-2301
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10930208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR601510OtherPROVIDER NO.
PRN739OtherPROVIDER NO.
PR88498OtherPROVIDER NO.
PR204114OtherPROVIDER NO.
PR9500060OtherPROVIDER NO.
PRG41207Medicare UPIN
PR204114OtherPROVIDER NO.