Healthcare Provider Details

I. General information

NPI: 1417040775
Provider Name (Legal Business Name): RODRIGO F. ROJAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15248 ELEVENTH ST
VICTORVILLE CA
92395-3704
US

IV. Provider business mailing address

PO BOX 661508
ARCADIA CA
91066-1508
US

V. Phone/Fax

Practice location:
  • Phone: 760-843-6099
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26519
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: