MEDICARE: CRISTIAN RODRIGUEZ M.D.

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	2080P0201X	Pediatric Allergy/Immunology Physician	01011239127	VA

General Provider Information

NPI Number	:	1366495228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIAN RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:	SUITE 1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-824-9397
Fax Number	:	703-820-5564

Provider Business Practice Location Address
First Line	:	3450 N BEAUREGARD ST
Second Line	:	SUITE 1
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1200
Country	:	US
Telephone Number	:	703-824-9397
Fax Number	:	703-820-5564

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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