Provider Demographics
NPI:1336126283
Name:RODRIGUEZ, LUIS SR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:RODRIGUEZ
Suffix:SR
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:PO BOX 3762
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3762
Mailing Address - Country:US
Mailing Address - Phone:787-752-7897
Mailing Address - Fax:787-768-0689
Practice Address - Street 1:AVE CAMPO RICO A-6 CASTELLANO GARDENS
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-752-7897
Practice Address - Fax:787-768-0689
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5681208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25790Medicare ID - Type Unspecified
PRE31222Medicare UPIN