MEDICARE: LEONEL L RODRIGUEZ MD A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033346994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONEL L RODRIGUEZ MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	205 N 1ST ST STE C
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1777
Country	:	US
Telephone Number	:	760-922-8330
Fax Number	:	760-922-8320

Provider Business Practice Location Address
First Line	:	205 N 1ST ST STE C
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1777
Country	:	US
Telephone Number	:	760-922-8330
Fax Number	:	760-922-8320

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LEONEL LAMON RODRIGUEZ
Credential	:	MD
Telephone Number	:	760-922-8330

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	02/29/2024

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