Provider Demographics
NPI:1528335577
Name:RODRIGUEZ, CARLOS RAFAEL
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RAFAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:RAFAEL
Other - Last Name:RODRIGUEZ-JAQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2771 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3027
Mailing Address - Country:US
Mailing Address - Phone:212-690-0303
Mailing Address - Fax:
Practice Address - Street 1:2771 FREDERICK DOUGLASS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039
Practice Address - Country:US
Practice Address - Phone:212-690-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117610282N00000X
NY268464282N00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital