Organization
PERSONAL HOME PHYSICIAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IVAN R. RODRIGUEZ M.D. (PRESIDENT)
(787) 713-6505
Entity
Organization
Contact information
Practice address
CARR. 31 JUNCOS PLAZA, LOCAL D-2, JUNCOS, PR 00777
(787) 713-6505
(787) 713-6505
Mailing address
PO BOX 1221, JUNCOS, PR 00777-1221
(787) 713-6505
(787) 713-6505
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15093
PR
208D00000X
General Practice Physician
15093
PR
208D00000X
General Practice Physician
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Other
Enumeration date
07/27/2006
Last updated
02/23/2012
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