Provider Demographics
NPI:1861557134
Name:RODRIGUEZ DE LEON, JUAN R (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:R
Last Name:RODRIGUEZ DE LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8459
Mailing Address - Country:US
Mailing Address - Phone:787-786-1200
Mailing Address - Fax:787-269-0077
Practice Address - Street 1:EDIF MEDICO HERMANAS DAVILA
Practice Address - Street 2:SUITE 202 VILLA RICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5041
Practice Address - Country:US
Practice Address - Phone:787-786-1200
Practice Address - Fax:787-269-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4298208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR340056-5OtherACAA
PRPE-0712OtherPAN AMERICAN LIFE
PR0404OtherINTERNATIONAL MEDICAL CAR
PR9-5585ROOtherTRIPLE-S INC.
PR6200051OtherHUMANA INSURANCE
PR06-3595OtherCRUZ AZUL
PR207071OtherPREFERRED HEALTH
PR600451OtherMEDICARE Y MUCHO MAS
PR340056-5OtherACAA