Provider Demographics
NPI:1346637170
Name:RODRIGUEZ, ADIB FEDERICO (MD)
Entity Type:Individual
Prefix:
First Name:ADIB
Middle Name:FEDERICO
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:PO BOX 516558
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0596
Mailing Address - Country:US
Mailing Address - Phone:702-671-5005
Mailing Address - Fax:702-895-4014
Practice Address - Street 1:1524 PINTO LN FL 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4195
Practice Address - Country:US
Practice Address - Phone:702-944-2828
Practice Address - Fax:702-944-2852
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0029897208000000X
NV16216208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1346637170Medicaid