Provider Demographics
NPI:1841245446
Name:MUNDO RODRIGUEZ, LUZ N SR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:N
Last Name:MUNDO RODRIGUEZ
Suffix:SR
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUZ
Other - Middle Name:N
Other - Last Name:MUNDO RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0563
Mailing Address - Country:US
Mailing Address - Phone:787-768-0388
Mailing Address - Fax:787-768-0388
Practice Address - Street 1:CALLE IGNACIO ARZUAGA
Practice Address - Street 2:#12
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986-0563
Practice Address - Country:US
Practice Address - Phone:787-768-0388
Practice Address - Fax:787-768-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4798174400000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist