Healthcare Provider Details

I. General information

NPI: 1962247791
Provider Name (Legal Business Name): RICHARD RODRIGUEZ MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MACARTHUR PL UNIT 1408
SANTA ANA CA
92707-6766
US

IV. Provider business mailing address

15 MACARTHUR PL UNIT 1408
SANTA ANA CA
92707-6766
US

V. Phone/Fax

Practice location:
  • Phone: 661-496-5950
  • Fax:
Mailing address:
  • Phone: 661-496-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD RODRIGUEZ
Title or Position: OWNER
Credential: MD
Phone: 661-496-5950