Provider Demographics
NPI:1144802786
Name:RODRIGUEZ ALVAREZ, GUSTAVO (MD)
Entity type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:
Last Name:RODRIGUEZ ALVAREZ
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:E19 CALLE CANARIO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3341
Mailing Address - Country:US
Mailing Address - Phone:787-619-1660
Mailing Address - Fax:
Practice Address - Street 1:E19 CALLE CANARIO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3341
Practice Address - Country:US
Practice Address - Phone:787-619-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22477208D00000X
PR15488I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice