Provider Demographics
NPI:1205898855
Name:RODRIGUEZ BENITEZ, PEDRO J (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:J
Last Name:RODRIGUEZ BENITEZ
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 1668
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1668
Mailing Address - Country:US
Mailing Address - Phone:787-691-9568
Mailing Address - Fax:
Practice Address - Street 1:CENTRO ISABELINO DE MEDICINA AVANZADA
Practice Address - Street 2:AVE AGUSTIN R CALERO KM 1.1
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8989207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3889921OtherCIGNA NUMBER
PR4508989OtherUIA NUMBER
PR067737OtherCRUZ AZUL NUMBER
PR81899OtherTRIPLE-S NUMBER
PR3889921OtherCIGNA NUMBER
PR81899Medicare ID - Type UnspecifiedMEDICARE NUMBER