| Dr Leonardo Rodriguez, MD | |
|
1896 E Babbitt Ln, San Luis, AZ 85349 | |
| (928) 722-6112 | |
| (928) 722-6113 |
| Full Name | Dr Leonardo Rodriguez |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 1896 E Babbitt Ln, San Luis, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801007000 | NPI | - | NPPES |
| 139738 | Medicaid | AZ | |
| 278820900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | ME98691 (Florida) | Secondary |
| 208000000X | Pediatrics | 52439 (Arizona) | Primary |
| Entity Name | San Luis Walk-in Clinic Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104228337 PECOS PAC ID: 2668361841 Enrollment ID: O20040514000795 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Leonardo Rodriguez, MD Po Box 1669, San Luis, AZ 85349-1669 Ph: (928) 722-6112 | Dr Leonardo Rodriguez, MD 1896 E Babbitt Ln, San Luis, AZ 85349 Ph: (928) 722-6112 |
Dr. Ramon Carampatan, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1896 E Babbit Ln, San Luis, AZ 85336 Phone: 928-722-6112 Fax: 928-550-5466 | |
Sucharitha Gunasekera, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 815 E Juan Sanchez Blvd, San Luis, AZ 85349 Phone: 928-627-3822 Fax: 928-627-3989 | |
Victoria Lasala, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1896 E Babbitt Ln, San Luis, AZ 85349 Phone: 928-722-6112 Fax: 928-722-6113 | |
Dr. Mohamed H. El-gasim, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1896 E Babbit Ln, San Luis, AZ 85336 Phone: 928-722-6112 | |
Daniel Anthony Calabrese, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1896 E. Babbit Lane, San Luis, AZ 85349 Phone: 928-722-6112 Fax: 928-722-6113 | |
Dr. Roderic Joel Hartman, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1896 E Babbitt Lane, San Luis, AZ 85349 Phone: 928-722-6112 Fax: 928-722-6113 |