MEDICARE: CLEM DULCE RODRIGUEZ MD

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	208600000X	Surgery Physician	A52544	CA
2	208D00000X	General Practice Physician	A52544	CA

General Provider Information

NPI Number	:	1134394034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEM DULCE RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	3720 LOCUST AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3308
Country	:	US
Telephone Number	:	323-426-9480
Fax Number	:	323-426-9630

Provider Business Practice Location Address
First Line	:	1200 N VERMONT AVE STE E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1760
Country	:	US
Telephone Number	:	323-426-9480
Fax Number	:	323-426-9630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	02/09/2015

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