Provider Demographics
NPI:1033346994
Name:LEONEL L RODRIGUEZ MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LEONEL L RODRIGUEZ MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:LAMON
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-922-8330
Mailing Address - Street 1:205 N 1ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1777
Mailing Address - Country:US
Mailing Address - Phone:760-922-8330
Mailing Address - Fax:760-922-8320
Practice Address - Street 1:205 N 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1777
Practice Address - Country:US
Practice Address - Phone:760-922-8330
Practice Address - Fax:760-922-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A546001Medicaid
CAG23739Medicare UPIN
CA00A546001Medicaid