Individual ProviderRafael RodriguezPediatricsAllopathic & Osteopathic PhysiciansPractice AddressPmb Suite 145, Ave. 90 Rio Hondo, Bayamon, PR 00961-3113(787) 378-1040(787) 270-1506PECOS EnrollmentBased on the most recent information from CMS, provider Rafael Rodriguez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:51 AM.Profile DetailsProvider ID1407921760Provider TypeIndividualFull NameRodriguez, RafaelTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date11/22/2006Last Updated7/8/2007Contact InformationPractice LocationPractice AddressPmb Suite 145, Ave. 90 Rio Hondo, Bayamon, PR 00961-3113Phone(787) 378-1040FaxUnlisted FaxMailing LocationMailing Address110 Esmeralda, Cielo Dorado Village, Vega Alta, PR 00692Phone(787) 270-1506Fax(787) 870-1508Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicense08088Puerto RicoProvider IdentifiersIDDescriptionIssuerID2-8088DescriptionOtherIssuerMCSPuerto RicoID82919-RODescriptionOtherIssuerTRIPLE-SPuerto RicoID203302DescriptionOtherIssuerPREFFERED HEALTHPuerto RicoID7232DescriptionOtherIssuerINTERNATIAL MEDICAL CARDPuerto RicoID7830002DescriptionOtherIssuerHUMANA INSURANCEPuerto RicoIDM-1915DescriptionOtherIssuerCRUZ AZULPuerto RicoID08088DescriptionOtherIssuerSTATE MEDICAL LICENSEPuerto Rico