Healthcare Provider Details

I. General information

NPI: 1972684744
Provider Name (Legal Business Name): ELIAS RODRIGUEZ JR. MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELIAS RODRIGUEZ M.D.

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 QUILL DR
DOWNEY CA
90242-2001
US

IV. Provider business mailing address

PO BOX 2331
DOWNEY CA
90242-0331
US

V. Phone/Fax

Practice location:
  • Phone: 562-940-6077
  • Fax: 562-803-0637
Mailing address:
  • Phone: 562-940-6077
  • Fax: 562-803-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA066783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: