Provider Demographics
NPI:1770504565
Name:RODRIGUEZ GONZALEZ, LUIS M (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:RODRIGUEZ GONZALEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SW 117TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4809
Mailing Address - Country:US
Mailing Address - Phone:786-755-2674
Mailing Address - Fax:
Practice Address - Street 1:7747 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4715
Practice Address - Country:US
Practice Address - Phone:813-603-4289
Practice Address - Fax:883-393-0869
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098164Medicare ID - Type UnspecifiedPROVIDER NUMBER