Individual provider Active NPI

Edda Luz Rodriguez, MD

  • Public Health & General Preventive Medicine Physician
  • Rio Piedras, PR
National Provider Identifier
1942419130
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
License
10355 Issued in PR
Practice address
1051E la Riviera
Cond. Medical Center Plaza 310
Rio Piedras, PR 00921
Phone
(787) 447-8575
Fax
(787) 781-3736
NPI assigned
May 22, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
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
Public Health & General Preventive Medicine Physician 2083P0901X 10355 PR Primary

Addresses

Primary practice location

1051E la Riviera
Cond. Medical Center Plaza 310
Rio Piedras, PR 00921

Mailing address

Private Mail Box 410
Pobox 70344
San Juan, PR 00936-8344
Phone (787) 447-8575

Other identifiers 1

IdentifierTypeStateIssuer
10355OtherPRLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
10355PRMDPublic Health & General Preventive Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942419130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PRIVATE MAIL BOX 410",
            "address_2": "POBOX 70344",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009368344",
            "telephone_number": "787-447-8575",
            "fax_number": "787-781-3736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051E LA RIVIERA",
            "address_2": "COND. MEDICAL CENTER PLAZA 310",
            "city": "RIO PIEDRAS",
            "state": "PR",
            "postal_code": "00921",
            "telephone_number": "787-447-8575",
            "fax_number": "787-781-3736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "EDDA",
        "middle_name": "LUZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "PR",
            "license": "10355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "10355",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Piedras, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.