Provider Demographics
NPI:1871560938
Name:RODRIGUEZ BENITEZ, JOSE M
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:RODRIGUEZ BENITEZ
Suffix:
Gender:M
Credentials:
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 1388
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1388
Mailing Address - Country:US
Mailing Address - Phone:787-745-0708
Mailing Address - Fax:787-745-0708
Practice Address - Street 1:MEDICO EXPRESS
Practice Address - Street 2:PLAZA GAUTIER BENITEZ NUM 21 1ER PISO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-745-0708
Practice Address - Fax:787-745-0708
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11074208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083247Medicare ID - Type UnspecifiedMEDICARE PROVIDER
PRG37207Medicare UPIN