Provider Demographics
NPI: | 1801818786 |
---|---|
Name: | LUIS RODRIGUEZ M.D. P.A. |
Entity Type: | Organization |
Organization Name: | LUIS RODRIGUEZ M.D. P.A. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | LUIS |
Authorized Official - Middle Name: | ANTONIO |
Authorized Official - Last Name: | RODRIGUEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 956-618-0404 |
Mailing Address - Street 1: | 1400 E RIDGE RD STE 8 |
Mailing Address - Street 2: | |
Mailing Address - City: | MCALLEN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78503-1536 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 956-618-0404 |
Mailing Address - Fax: | 956-618-3177 |
Practice Address - Street 1: | 1400 E RIDGE RD STE 8 |
Practice Address - Street 2: | |
Practice Address - City: | MCALLEN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78503-1536 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-618-0404 |
Practice Address - Fax: | 956-618-3177 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | J7164 | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |