Provider Demographics
NPI:1861912099
Name:RODRIGUEZ, JAMINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:JAMINETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
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:RR 4 BOX 2784
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9403
Mailing Address - Country:US
Mailing Address - Phone:787-422-2535
Mailing Address - Fax:
Practice Address - Street 1:CARR 829 KM 1.1
Practice Address - Street 2:BO BUENA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9403
Practice Address - Country:US
Practice Address - Phone:787-422-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19682208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR000000000OtherNONE
00000000000OOtherNONE