Healthcare Provider Details

I. General information

NPI: 1598109027
Provider Name (Legal Business Name): DARRYL J RODRIGUES MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 N GAREY AVE
POMONA CA
91767-2918
US

IV. Provider business mailing address

600 N MOUNTAIN AVE STE A104
UPLAND CA
91786-4359
US

V. Phone/Fax

Practice location:
  • Phone: 909-931-1033
  • Fax:
Mailing address:
  • Phone: 909-931-1033
  • Fax: 909-981-8976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG74969
License Number StateCA

VIII. Authorized Official

Name: DR. DARRYL J RODRIGUES
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 909-931-1033