MEDICARE: DR. LUIS A RODRIGUEZ M.D.

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	2085R0202X	Diagnostic Radiology Physician	2085R0202X	PR

General Provider Information

NPI Number	:	1871582072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS A RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 364964
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-4964
Country	:	US
Telephone Number	:	787-273-4245
Fax Number	:	787-273-1717

Provider Business Practice Location Address
First Line	:	1525 AVE AMERICO MIRANDA
Second Line	:	CAPARRA TERRACE
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2127
Country	:	US
Telephone Number	:	787-273-4245
Fax Number	:	787-271-2717

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	12/05/2008

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