Provider Demographics
NPI:1053011882
Name:RODRIGUEZ PANESSO, ROY (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:RODRIGUEZ PANESSO
Suffix:
Gender:M
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:COUNTRY CLUB 215
Mailing Address - Street 2:HB1
Mailing Address - City:CAROLINA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00982
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COUNTRY CLUB 215
Practice Address - Street 2:HB1
Practice Address - City:CAROLINA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00982
Practice Address - Country:UM
Practice Address - Phone:787-399-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical