Provider Demographics
NPI:1548257421
Name:GONZALEZ-RODRIGUEZ, MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:GONZALEZ-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:PO BOX 8878
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8878
Mailing Address - Country:US
Mailing Address - Phone:787-378-6731
Mailing Address - Fax:787-768-2722
Practice Address - Street 1:CARRETERA 3, KM. 8.3, AVE. 65 DE INFANTERIA
Practice Address - Street 2:HOSPITAL UPR DR. FEDERICO TRILLA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:787-276-2205
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8908174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080756Medicare PIN
PRE66556Medicare UPIN