Provider Demographics
NPI:1083673206
Name:DR VICTORIO C RODRIGUEZ MD PMA CO
Entity Type:Organization
Organization Name:DR VICTORIO C RODRIGUEZ MD PMA CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIO
Authorized Official - Middle Name:CAJIGAL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-441-4432
Mailing Address - Street 1:3345 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1547
Mailing Address - Country:US
Mailing Address - Phone:216-441-4432
Mailing Address - Fax:
Practice Address - Street 1:3345 E 55TH ST
Practice Address - Street 2:7791 HOERTZ RD., PARMA,OHIO,44134(BUSINESS MAILING)
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1547
Practice Address - Country:US
Practice Address - Phone:216-441-4432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034349261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0207912Medicaid
OHA74277Medicare UPIN
OH0207912Medicaid