Healthcare Provider Details

I. General information

NPI: 1366495228
Provider Name (Legal Business Name): CRISTIAN RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 N BEAUREGARD ST SUITE 1
ALEXANDRIA VA
22302-1200
US

IV. Provider business mailing address

3450 N BEAUREGARD ST SUITE 1
ALEXANDRIA VA
22302-1200
US

V. Phone/Fax

Practice location:
  • Phone: 703-824-9397
  • Fax: 703-820-5564
Mailing address:
  • Phone: 703-824-9397
  • Fax: 703-820-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number01011239127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: