Luis Giovani Custodio-Rodriguez, M.D
Individual provider Active NPI Internal Medicine Physician · Isabela, PR
NPI 1669919528 · NPPES record last updated Oct 1, 2025
Key facts
- NPI
- 1669919528
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 19523 (PR)
- Practice address
- 3106 Calle Bermuda
Urb Islazul
Isabela, PR 00662-6354 - Phone
- (787) 455-1631
- NPI assigned
- Jan 30, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
29 Calle Basilio Catala
Apt 303
Guaynabo, PR 00971
3106 Calle Bermuda
Isabela, PR 00662
PO Box
Aguadilla, PR 00605
PO Box
Moca, PR 00676
PO Box
Suite 68
Moca, PR 00676-0068
Hospital & facility affiliations
- Hospital San Carlos Borromeo
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251229000946 | PR | Practitioner - Internal Medicine | 0749776862 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19523 | PR | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCV Health Group LLC | Single Specialty | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 19523 | PR | Yes |
Addresses
Primary practice location
3106 Calle Bermuda
Urb Islazul
Isabela, PR 00662-6354
Mailing address
3106 Calle Bermuda
Isabela, PR 00662-6354
Phone (787) 455-1631
Other providers in Isabela, PR
- Solangel Cruz Valle
- Shayra Liz Cruz Vazquez
- Pedro J. Cruz-Quiles
- Albert Andres Cruz
- Janitza Enid Cruz
- CVDP Health Management LLC
- Saallahheim Ra Davis
- Laura Marie Del Valle Perez
- Patricia Elena Delgado
- Axel Deliz
All providers in Isabela, PR · Internal Medicine Physician in Puerto Rico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.