Provider Demographics
NPI:1144455353
Name:RODRIGUEZ RODRIGUEZ, JESUS (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:RODRIGUEZ 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:AU17 CALLE RIO TURABO
Mailing Address - Street 2:VALLE VERDE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3262
Mailing Address - Country:US
Mailing Address - Phone:787-261-6006
Mailing Address - Fax:787-261-6006
Practice Address - Street 1:18 CALLE 1
Practice Address - Street 2:SUITE 400
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1768
Practice Address - Country:US
Practice Address - Phone:787-774-3344
Practice Address - Fax:787-774-0549
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3030174400000X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No273R00000XHospital UnitsPsychiatric Unit