MEDICARE: DR. LUIS MANUEL RODRIGUEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	1324319	ZZ

General Provider Information

NPI Number	:	1760632210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS MANUEL RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	3530 BEYER BLVD APT 102
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-1353
Country	:	US
Telephone Number	:	877-838-2248
Fax Number	:	877-839-2248

Provider Business Practice Location Address
First Line	:	CALLE 4TA DIAZ MIRON 8150 - 205
Second Line	:	ZONA CENTRO
City	:	TIJUANA
State	:	BC
Zip	:	22000
Country	:	MX
Telephone Number	:	877-839-2248
Fax Number	:	877-839-2248

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2008
Last Update Date	:	06/20/2025

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