Provider Demographics
NPI:1912967993
Name:RODRIGUEZ MIMOSO, ANTONIO JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:JUAN
Last Name:RODRIGUEZ MIMOSO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:AVE FD ROOSEVELT #400
Mailing Address - Street 2:SUITE304
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-763-6065
Mailing Address - Fax:787-753-0054
Practice Address - Street 1:AVE FD ROOSEVELT #400
Practice Address - Street 2:SUITE304
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-763-6065
Practice Address - Fax:787-753-0054
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-05-17
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Provider Licenses
StateLicense IDTaxonomies
PR12583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH68138Medicare UPIN