Provider Demographics
NPI:1497797559
Name:RODRIGUEZ, ALVARO H (MD)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:H
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 1:225 CABRILLO HWY S
Mailing Address - Street 2:200 A
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-8200
Mailing Address - Country:US
Mailing Address - Phone:650-578-7100
Mailing Address - Fax:650-298-6891
Practice Address - Street 1:225 CABRILLO HWY S
Practice Address - Street 2:200 A
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-8200
Practice Address - Country:US
Practice Address - Phone:650-578-7100
Practice Address - Fax:650-298-6891
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41323208100000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A413230Medicaid
CA00A413230Medicaid
CA00A413230Medicare ID - Type Unspecified