Healthcare Provider Details

I. General information

NPI: 1265483192
Provider Name (Legal Business Name): RAFAEL RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 COTTONWOOD ST DEPT OF PATHOLOGY
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

P.O. BOX 340850
SACRAMENTO CA
95834-0850
US

V. Phone/Fax

Practice location:
  • Phone: 916-634-7767
  • Fax: 916-672-1524
Mailing address:
  • Phone: 916-634-7767
  • Fax: 916-672-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA85779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: