Healthcare Provider Details

I. General information

NPI: 1366653453
Provider Name (Legal Business Name): LUIS F RODRIGUEZ TERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 FERNANDEZ JUNCOS AVE,
SAN JUAN PR
00907
US

IV. Provider business mailing address

703 FERNANDEZ JUNCOS AVE,
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-977-7070
  • Fax: 787-977-7072
Mailing address:
  • Phone: 787-977-7070
  • Fax: 787-977-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number12599
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: