Healthcare Provider Details

I. General information

NPI: 1457436719
Provider Name (Legal Business Name): LORNA RODRIGUEZ MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 11/27/2023
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. DUARTE ROAD
DUARTE CA
91010
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MA03941500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberC162435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: