Provider Demographics
NPI:1699119503
Name:RODRIGUEZ, LUIS ANGEL (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:223 CIBECUE CIRCLE RD.
Mailing Address - Street 2:SAN CARLOS PHS INDIAN HOSPITAL
Mailing Address - City:SAN CARLOS
Mailing Address - State:AZ
Mailing Address - Zip Code:85550-0208
Mailing Address - Country:US
Mailing Address - Phone:928-475-7219
Mailing Address - Fax:928-475-7370
Practice Address - Street 1:223 CIBECUE CIRCLE
Practice Address - Street 2:SAN CARLOS PHS INDIAN HOSPITAL
Practice Address - City:SAN CARLOS
Practice Address - State:AZ
Practice Address - Zip Code:85550-0208
Practice Address - Country:US
Practice Address - Phone:928-475-7219
Practice Address - Fax:928-475-7370
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine