Provider Demographics
NPI:1871582072
Name:RODRIGUEZ, LUIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
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:PO BOX 364964
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4964
Mailing Address - Country:US
Mailing Address - Phone:787-273-4245
Mailing Address - Fax:787-273-1717
Practice Address - Street 1:1525 AVE AMERICO MIRANDA
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2127
Practice Address - Country:US
Practice Address - Phone:787-273-4245
Practice Address - Fax:787-271-2717
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085R0202X2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE10153Medicare UPIN
PR0081536Medicare PIN