Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16080 | PR |
N | 208D00000X | General Practice Physician | 4301503877 | MI |
NPI | 1013136431 |
---|---|
Provider Name | Dr. Luis E. Rodriguez |
First Address | Guaynabo, PR 00969-4953 |
Second Address | Guaynabo, PR 00969-4953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 30/03/2021 |