Healthcare Provider Details

I. General information

NPI: 1780543595
Provider Name (Legal Business Name): MR. RONALD ALFREDO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 WATERCRESS CT
LOS BANOS CA
93635-8564
US

IV. Provider business mailing address

1607 WATERCRESS CT
LOS BANOS CA
93635-8564
US

V. Phone/Fax

Practice location:
  • Phone: 510-439-6021
  • Fax:
Mailing address:
  • Phone: 510-439-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: