Healthcare Provider Details

I. General information

NPI: 1487973103
Provider Name (Legal Business Name): YVAN RODRIGUES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVAN TRAN MD

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 22ND ST
SANTA MONICA CA
90403-2008
US

IV. Provider business mailing address

1908 THOMES AVE STE 12550
CHEYENNE WY
82001-3527
US

V. Phone/Fax

Practice location:
  • Phone: 303-776-5298
  • Fax:
Mailing address:
  • Phone: 303-776-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301086272
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberCDRH.0064752
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: