Provider Demographics
NPI:1053498980
Name:RODRIGUEZ, NOAH (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NOE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6650 ALTON PKWY
Mailing Address - Street 2:MEDICAL OFFICE BUILDING 2, 3RD FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3734
Mailing Address - Country:US
Mailing Address - Phone:949-932-5685
Mailing Address - Fax:949-932-6393
Practice Address - Street 1:6650 ALTON PKWY
Practice Address - Street 2:MEDICAL OFFICE BUILDING 2, 3RD FLOOR
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3734
Practice Address - Country:US
Practice Address - Phone:949-932-5685
Practice Address - Fax:949-932-6393
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A906190Medicaid
00A906190Medicare ID - Type Unspecified
CA00A906190Medicaid