Healthcare Provider Details

I. General information

NPI: 1770554669
Provider Name (Legal Business Name): HECTOR J RODRIGUEZ M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S BEVERLY DR STE 425
LOS ANGELES CA
90035-1192
US

IV. Provider business mailing address

1125 S BEVERLY DR STE 425
LOS ANGELES CA
90035-1192
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-7300
  • Fax: 310-274-7301
Mailing address:
  • Phone: 310-274-7300
  • Fax: 310-742-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA29728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: