Provider Demographics
NPI:1326075292
Name:RODRIGUEZ, RAMON G (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:G
Last Name: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 1:516 W ATEN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9805
Mailing Address - Country:US
Mailing Address - Phone:760-355-7730
Mailing Address - Fax:760-355-7731
Practice Address - Street 1:528 G ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2402
Practice Address - Country:US
Practice Address - Phone:760-344-1881
Practice Address - Fax:760-344-5421
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47485ZOtherBLUE SHIELD OF CALIFORNIA
CA00G278940Medicaid
CAWG27894BOtherMEDICARE PTAN
CAGR0066314OtherMEDI CAL GROUP
A43535Medicare UPIN
CAWA27894GMedicare PIN
CAW13536EMedicare PIN
CAGR0066314OtherMEDI CAL GROUP
CACC6635Medicare PIN