Healthcare Provider Details

I. General information

NPI: 1447576244
Provider Name (Legal Business Name): POPPI ELISA RODRIGUEZ-WEBB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 S FAIRMONT AVE
LODI CA
95240-5118
US

IV. Provider business mailing address

975 S FAIRMONT AVE PO BOX 3004
LODI CA
95240-5118
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-3411
  • Fax:
Mailing address:
  • Phone: 209-334-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2012013858
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A13292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: