Provider Demographics
NPI:1669919528
Name:CUSTODIO-RODRIGUEZ, LUIS GIOVANI (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GIOVANI
Last Name:CUSTODIO-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 1:3106 CALLE BERMUDA
Mailing Address - Street 2:URB ISLAZUL
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:787-455-1631
Mailing Address - Fax:
Practice Address - Street 1:3106 CALLE BERMUDA
Practice Address - Street 2:URB ISLAZUL
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-6354
Practice Address - Country:US
Practice Address - Phone:787-455-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19523208D00000X, 282N00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No282N00000XHospitalsGeneral Acute Care Hospital