Provider Demographics
NPI:1083664858
Name:HERNANDEZ-RODRIGUEZ, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HERNANDEZ-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E 4TH ST STE B-C
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2114
Mailing Address - Country:US
Mailing Address - Phone:951-956-2131
Mailing Address - Fax:951-956-2151
Practice Address - Street 1:180 E 4TH ST STE B-C
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2114
Practice Address - Country:US
Practice Address - Phone:951-956-2131
Practice Address - Fax:951-956-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
22846Medicare ID - Type Unspecified
I23692Medicare UPIN