Provider Demographics
NPI:1699068858
Name:DR. REYNALDO DE JESUS RODRIGUEZ PSC
Entity type:Organization
Organization Name:DR. REYNALDO DE JESUS RODRIGUEZ PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-8174
Mailing Address - Street 1:909 AVE TITO CASTRO
Mailing Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 614
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4728
Mailing Address - Country:US
Mailing Address - Phone:787-840-8174
Mailing Address - Fax:787-843-2084
Practice Address - Street 1:909 AVE TITO CASTRO
Practice Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 614
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4728
Practice Address - Country:US
Practice Address - Phone:787-840-8174
Practice Address - Fax:787-843-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13269207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1881791663OtherNPI