Healthcare Provider Details

I. General information

NPI: 1972793685
Provider Name (Legal Business Name): DAVID RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 J ST SUITE 250
SACRAMENTO CA
95819-3631
US

IV. Provider business mailing address

3939 J ST
SACRAMENTO CA
95819-3631
US

V. Phone/Fax

Practice location:
  • Phone: 916-451-2888
  • Fax:
Mailing address:
  • Phone: 916-455-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA79225
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA79225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: