Provider Demographics
NPI:1467694992
Name:RODRIGUEZ, ARCHIBALD EDMUNDO (DC)
Entity Type:Individual
Prefix:
First Name:ARCHIBALD
Middle Name:EDMUNDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 LINDERO CYN. RD.
Mailing Address - Street 2:#270
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377
Mailing Address - Country:US
Mailing Address - Phone:805-497-8581
Mailing Address - Fax:805-497-8582
Practice Address - Street 1:1220 LA VENTA DR.
Practice Address - Street 2:#205A
Practice Address - City:WEST LAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-497-8581
Practice Address - Fax:805-497-8582
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor