Provider Demographics
NPI:1760014773
Name:RENDON, LUIS GABRIEL
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GABRIEL
Last Name:RENDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BE16 VIA ERIE
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6131
Mailing Address - Country:US
Mailing Address - Phone:787-342-1917
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF PUERTO RICO, MEDICAL SCIENCES CAMPUS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-5067
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program