Provider Demographics
NPI:1508933615
Name:RODRIGUEZ, ROMUALDO (MD)
Entity Type:Individual
Prefix:
First Name:ROMUALDO
Middle Name:
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 3868
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-3868
Mailing Address - Country:US
Mailing Address - Phone:951-929-2794
Mailing Address - Fax:951-677-0381
Practice Address - Street 1:2150 SO. STATE ST.
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92546-3868
Practice Address - Country:US
Practice Address - Phone:951-929-2794
Practice Address - Fax:951-677-0381
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional