Individual provider Active NPI

Lus Angel Rodriguez, DMD

  • General Practice Dentistry
  • San German, PR
National Provider Identifier
1033128889
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1392 Issued in PR
Practice address
175 Ave Univ Interamericana
Suite 4 la Quinta Shopping Court
San German, PR 00683-4308
Phone
(787) 892-1102
Fax
(787) 892-1102
NPI assigned
Aug 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1392 PR Primary

Addresses

Primary practice location

175 Ave Univ Interamericana
Suite 4 la Quinta Shopping Court
San German, PR 00683-4308

Mailing address

175 Ave Univ Interamericana
Suite 4 la Quinta Shopping Court
San German, PR 00683-4308
Phone (787) 892-1102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160107000124 PR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9739481862

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1392PRMDOccupational Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033128889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 AVE UNIV INTERAMERICANA",
            "address_2": "SUITE 4 LA QUINTA SHOPPING COURT",
            "city": "SAN GERMAN",
            "state": "PR",
            "postal_code": "006834308",
            "telephone_number": "787-892-1102",
            "fax_number": "787-892-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 AVE UNIV INTERAMERICANA",
            "address_2": "SUITE 4 LA QUINTA SHOPPING COURT",
            "city": "SAN GERMAN",
            "state": "PR",
            "postal_code": "006834308",
            "telephone_number": "787-892-1102",
            "fax_number": "787-892-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "LUS",
        "middle_name": "ANGEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "1392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San German, PR

Sources for this page

Verify at the official NPI Registry.