Provider Demographics
NPI:1518016229
Name:RODRIGUEZ, RAFAEL ANGEL (MDFACOG)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANGEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MDFACOG
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 128
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0128
Mailing Address - Country:US
Mailing Address - Phone:787-868-6474
Mailing Address - Fax:787-868-8900
Practice Address - Street 1:CARR #2 KM 133.5 BO GUANABANO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-6474
Practice Address - Fax:787-868-8900
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8531207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD34258Medicare UPIN