Healthcare Provider Details

I. General information

NPI: 1043228661
Provider Name (Legal Business Name): JOSE M RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 KEYSTONE PACIFIC PKWY UNIT B
PATTERSON CA
95363-8874
US

IV. Provider business mailing address

1700 KEYSTONE PACIFIC PARKWAY UNIT B
PATTERSON CA
95363
US

V. Phone/Fax

Practice location:
  • Phone: 209-892-9100
  • Fax: 209-892-9102
Mailing address:
  • Phone: 209-892-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG80303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: