Healthcare Provider Details

I. General information

NPI: 1356397186
Provider Name (Legal Business Name): FRED RHODE STODDARD M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 OREGON ST
VALLEJO CA
94590-3254
US

IV. Provider business mailing address

7250 AUBURN BLVD # 120
CITRUS HEIGHTS CA
95610-3850
US

V. Phone/Fax

Practice location:
  • Phone: 707-649-4007
  • Fax: 707-649-4077
Mailing address:
  • Phone: 916-572-7755
  • Fax: 916-200-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG35967
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10-00001679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: