Healthcare Provider Details

I. General information

NPI: 1801874375
Provider Name (Legal Business Name): JORGE ERNESTO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4791 E PALM CANYON DR STE 100
PALM SPRINGS CA
92264-5232
US

IV. Provider business mailing address

4791 E PALM CANYON DR STE 100
PALM SPRINGS CA
92264-5232
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-7930
  • Fax: 760-834-7931
Mailing address:
  • Phone: 760-834-7930
  • Fax: 760-834-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG54429
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG54429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: