Provider Demographics
NPI:1801857560
Name:RODRIGUEZ, LUIS A (MD)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120427
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-0427
Mailing Address - Country:US
Mailing Address - Phone:210-223-3543
Mailing Address - Fax:210-227-0282
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:#1075
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207
Practice Address - Country:US
Practice Address - Phone:210-223-3543
Practice Address - Fax:210-227-0282
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096319103Medicaid
TX096319103Medicaid