Provider Demographics
NPI:1295866614
Name:RODRIGUEZ, BEVERLY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 QUARRY ROAD
Mailing Address - Street 2:STANFORD CHILD AND ADOLESCENT PSYCHIATRY
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305
Mailing Address - Country:US
Mailing Address - Phone:650-723-5511
Mailing Address - Fax:650-724-7389
Practice Address - Street 1:401 QUARRY ROAD
Practice Address - Street 2:STANFORD CHILD AND ADOLESCENT PSYCHIATRY
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305
Practice Address - Country:US
Practice Address - Phone:650-723-5511
Practice Address - Fax:650-724-7389
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA947462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry