Provider Demographics
NPI:1922111343
Name:RODRIGUEZ, CARLOS LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:LUIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13575
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3575
Mailing Address - Country:US
Mailing Address - Phone:787-863-2236
Mailing Address - Fax:787-863-2236
Practice Address - Street 1:UNION # 10 ESQ. CELIS AGUILERA
Practice Address - Street 2:FAJARDO MEDICAL PLAZA OFIC. 104
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-2236
Practice Address - Fax:787-863-2236
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8770208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082925Medicare ID - Type Unspecified