Provider Demographics
NPI:1063504447
Name:RODRIGUEZ, MARITINA SOLOMON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARITINA
Middle Name:SOLOMON
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1595 SOQUEL DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1719
Practice Address - Country:US
Practice Address - Phone:831-476-1551
Practice Address - Fax:831-476-3241
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72787207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADD5840OtherMEDICARE RR
CA00A727870Medicaid
CAZZZ66323ZOtherBLUE SHIELD PROV. ID
CAZZZ01875ZMedicare ID - Type Unspecified
CA00A727870Medicaid