Provider Demographics
NPI:1013950260
Name:RODRIGUEZ, ERNESTO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:LUIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 CALLE TEGUCIGALPA
Mailing Address - Street 2:LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2345
Mailing Address - Country:US
Mailing Address - Phone:787-754-8327
Mailing Address - Fax:787-786-6940
Practice Address - Street 1:CL. HOARE, ESQUINA SERRA
Practice Address - Street 2:CDT GUALBERTO RABELL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-721-7086
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics