1942419130 NPI number — DR. EDDA LUZ RODRIGUEZ MD

Table of content: DR. EDDA LUZ RODRIGUEZ MD (NPI 1942419130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942419130 NPI number — DR. EDDA LUZ RODRIGUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
EDDA
Provider Middle Name:
LUZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942419130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PRIVATE MAIL BOX 410
Provider Second Line Business Mailing Address:
POBOX 70344
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-8344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-447-8575
Provider Business Mailing Address Fax Number:
787-781-3736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051E LA RIVIERA
Provider Second Line Business Practice Location Address:
COND. MEDICAL CENTER PLAZA 310
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-447-8575
Provider Business Practice Location Address Fax Number:
787-781-3736
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  10355 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10355 . This is a "LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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