Healthcare Provider Details

I. General information

NPI: 1497797559
Provider Name (Legal Business Name): ALVARO H RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S 200 A
HALF MOON BAY CA
94019-8200
US

IV. Provider business mailing address

225 CABRILLO HWY S 200 A
HALF MOON BAY CA
94019-8200
US

V. Phone/Fax

Practice location:
  • Phone: 650-578-7100
  • Fax: 650-298-6891
Mailing address:
  • Phone: 650-578-7100
  • Fax: 650-298-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA41323
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA41323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: