Provider Demographics
NPI:1669527990
Name:RODRIGUEZ SASTRE, LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:RODRIGUEZ SASTRE
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:URB LAS COLINAS
Mailing Address - Street 2:2 CALLE 1
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-883-2169
Mailing Address - Fax:787-883-0028
Practice Address - Street 1:URB LAS COLINAS
Practice Address - Street 2:2 CALLE 1
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-2169
Practice Address - Fax:787-883-0028
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98210Medicare ID - Type UnspecifiedPROVIDER NUMBER