Basic Information
| Provider Information | |||||||||
| NPI: | 1326492489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ RAMOS | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | ENRIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 377 | ||||||||
| Address2: | |||||||||
| City: | MERCEDITA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007150377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872364506 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2213 PONCE BYP | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408686 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2016 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 019578 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 390200000X | 13909-I | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 019578 | PR | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | I20170511002419 | 05 | PR | MEDICAID |