Healthcare Provider Details

I. General information

NPI: 1649420381
Provider Name (Legal Business Name): LUIS L. RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 RIVERA AVE
EL PASO TX
79905-2415
US

IV. Provider business mailing address

3607 RIVERA AVE
EL PASO TX
79905-2415
US

V. Phone/Fax

Practice location:
  • Phone: 915-857-2638
  • Fax: 915-857-8971
Mailing address:
  • Phone: 915-857-2638
  • Fax: 915-857-8971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP1220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: