Healthcare Provider Details

I. General information

NPI: 1811457625
Provider Name (Legal Business Name): KEVIN RODRIGUEZ AMENERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S STRATFORD AVE STE B
SANTA MARIA CA
93454-5908
US

IV. Provider business mailing address

316 S STRATFORD AVE STE B
SANTA MARIA CA
93454-5908
US

V. Phone/Fax

Practice location:
  • Phone: 805-332-8446
  • Fax: 805-332-8483
Mailing address:
  • Phone: 805-332-8446
  • Fax: 805-332-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA196008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: