Provider Demographics
NPI:1568849230
Name:RODRIGUEZ SILVA, JETSEN AMAURY (MD)
Entity type:Individual
Prefix:
First Name:JETSEN
Middle Name:AMAURY
Last Name:RODRIGUEZ SILVA
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 39
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0039
Mailing Address - Country:US
Mailing Address - Phone:787-500-1270
Mailing Address - Fax:
Practice Address - Street 1:CARR 132 KM 22.1 BO CANAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2687
Practice Address - Country:US
Practice Address - Phone:787-500-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6925208600000X
PR390200000X
FL390200000X
PR21796208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program