Healthcare Provider Details

I. General information

NPI: 1538165196
Provider Name (Legal Business Name): RODOLFO E SAENZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 201
RIVERSIDE CA
92506-0104
US

IV. Provider business mailing address

4646 BROCKTON AVE STE 201
RIVERSIDE CA
92506-0104
US

V. Phone/Fax

Practice location:
  • Phone: 951-585-1800
  • Fax: 951-585-1801
Mailing address:
  • Phone: 951-585-1800
  • Fax: 951-585-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35074074
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA055646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: