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NPI Code Detail

MEDICARE: REBECCAH RHENAE RODRIGUEZ D.O.

MEDICARE: REBECCAH RHENAE RODRIGUEZ D.O.
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
1207Q00000XFamily Medicine Physician4720AZ
2207QS0010XSports Medicine (Family Medicine) Physician20A10913CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EB240ZOTHERCAINDIVIDUAL PTAN
2W12026OTHERCAGROUP PTAN

General Provider Information

NPI Number : 1922288802
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCAH RHENAE RODRIGUEZ D.O.
Provider Business Mailing Address
First Line : 8901 ACTIVITY RD
Second Line : STE 100
City : SAN DIEGO
State : CA
Zip : 92126-4436
Country : US
Telephone Number : 858-793-7860
Fax Number : 858-436-1289
Provider Business Practice Location Address
First Line : 4010 SORRENTO VALLEY BLVD
Second Line : SUITE 300
City : SAN DIEGO
State : CA
Zip : 92121-1432
Country : US
Telephone Number : 858-793-7860
Fax Number : 858-436-1289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2007
Last Update Date : 04/10/2020

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