Healthcare Provider Details

I. General information

NPI: 1043776347
Provider Name (Legal Business Name): KAREN RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN THOMPSON MD

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 06/11/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4077 FIFTH AVE # MER-35
SAN DIEGO CA
92103-2105
US

IV. Provider business mailing address

1965 ELM TERRACE CIR
BROOKFIELD WI
53045-5006
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: