Provider Demographics
NPI:1164472007
Name:RODRIGUEZ HERNANDEZ, LUIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:RODRIGUEZ HERNANDEZ
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 1:1633 CALLE JOSEMARIA ESCRIVA
Mailing Address - Street 2:EXT. ALHAMBRA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3809
Mailing Address - Country:US
Mailing Address - Phone:787-579-4231
Mailing Address - Fax:787-844-7975
Practice Address - Street 1:1326 CALLE SALUD EL SENORIAL PLAZA SUITE 103
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1689
Practice Address - Country:US
Practice Address - Phone:787-844-7975
Practice Address - Fax:787-844-7975
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0099296Medicare PIN
PRD32375Medicare UPIN