Provider Demographics
NPI:1033172002
Name:RODERICK A COMUNALE II MD INC
Entity Type:Organization
Organization Name:RODERICK A COMUNALE II MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:COMUNALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-551-0276
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-1188
Mailing Address - Country:US
Mailing Address - Phone:858-551-0276
Mailing Address - Fax:858-454-9796
Practice Address - Street 1:502 EUCLID AVE STE 205
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2993
Practice Address - Country:US
Practice Address - Phone:858-551-0276
Practice Address - Fax:848-454-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43885207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438851Medicaid
CA00A438850Medicaid
CAE93200Medicare UPIN
CAA438885Medicare ID - Type Unspecified
CA00A438851Medicaid