Provider Demographics
NPI:1386609089
Name:RODRIGUEZ, ADOLFO R (MD)
Entity type:Individual
Prefix:MR
First Name:ADOLFO
Middle Name:R
Last Name:RODRIGUEZ
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:PMB 176 1353
Mailing Address - Street 2:RD 19
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2700
Mailing Address - Country:US
Mailing Address - Phone:787-723-5585
Mailing Address - Fax:787-722-3660
Practice Address - Street 1:1952 ASHFORD AVE
Practice Address - Street 2:COND ADA LIGIA STE D1
Practice Address - City:SANRUCE
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-5585
Practice Address - Fax:787-722-3660
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10239207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
82590Medicare ID - Type Unspecified
F00988Medicare UPIN