1962477067 NPI number — HECTOR F RODRIGUEZ MD

Table of content: HECTOR F RODRIGUEZ MD (NPI 1962477067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962477067 NPI number — HECTOR F RODRIGUEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
HECTOR
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962477067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90510-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-792-3914
Provider Business Mailing Address Fax Number:
855-898-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S SEPULVEDA BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90266-6876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-546-3461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  11629 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: A92346 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1962477067 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220301203A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100507156 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807890400 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 968422 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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