Healthcare Provider Details

I. General information

NPI: 1295866614
Provider Name (Legal Business Name): BEVERLY RODRIGUEZ M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 QUARRY ROAD STANFORD CHILD AND ADOLESCENT PSYCHIATRY
STANFORD CA
94305
US

IV. Provider business mailing address

401 QUARRY ROAD STANFORD CHILD AND ADOLESCENT PSYCHIATRY
STANFORD CA
94305
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-5511
  • Fax: 650-724-7389
Mailing address:
  • Phone: 650-723-5511
  • Fax: 650-724-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA94746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: