Healthcare Provider Details

I. General information

NPI: 1255134276
Provider Name (Legal Business Name): JOSE RODRIGUEZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 BUNKER HILL ST STE 204
SAN DIEGO CA
92109-5706
US

IV. Provider business mailing address

3023 BUNKER HILL ST STE 204
SAN DIEGO CA
92109-5706
US

V. Phone/Fax

Practice location:
  • Phone: 619-396-8959
  • Fax: 619-330-8826
Mailing address:
  • Phone: 619-396-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE WATSON
Title or Position: ADMIN
Credential:
Phone: 619-396-8959