Healthcare Provider Details

I. General information

NPI: 1639627185
Provider Name (Legal Business Name): LUIS A RODRIGUEZ PHD, MPH, RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 12/17/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 4TH ST BOX 4002
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

550 16TH ST FL 2
SAN FRANCISCO CA
94158-2545
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-8247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1024355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: