Healthcare Provider Details

I. General information

NPI: 1538080312
Provider Name (Legal Business Name): ELODIA C RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13885 CHOLAME RD
VICTORVILLE CA
92392-2609
US

IV. Provider business mailing address

13885 CHOLAME RD
VICTORVILLE CA
92392-2609
US

V. Phone/Fax

Practice location:
  • Phone: 760-792-8830
  • Fax:
Mailing address:
  • Phone: 909-825-7084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number95442705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: