Provider Demographics
NPI:1942285101
Name:RODRIGUEZ-MORA, LUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:M
Last Name:RODRIGUEZ-MORA
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 597
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0597
Mailing Address - Country:US
Mailing Address - Phone:787-878-4800
Mailing Address - Fax:787-817-1237
Practice Address - Street 1:55 CALLE PALMA
Practice Address - Street 2:SUSONI MEDICAL BUILDING, SUITE 101
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4526
Practice Address - Country:US
Practice Address - Phone:787-878-4800
Practice Address - Fax:787-817-1237
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4282207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5774OtherINTERNATIONAL MEDICAL CAR
PR991211OtherMEDICARE Y MUCHO MAS
PR063758OtherCRUZ AZUL DE PUERTO RICO
PR95413OtherTRIPLE-S
PR95413OtherTRIPLE-S
PR063758OtherCRUZ AZUL DE PUERTO RICO