Provider Demographics
NPI:1508936675
Name:RODRIGUEZ, GERONIMO GIRALDO (MD)
Entity Type:Individual
Prefix:
First Name:GERONIMO
Middle Name:GIRALDO
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 1:31 W BELLEVUE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2501
Mailing Address - Country:US
Mailing Address - Phone:626-577-8138
Mailing Address - Fax:626-577-7458
Practice Address - Street 1:31 W BELLEVUE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2501
Practice Address - Country:US
Practice Address - Phone:626-577-8138
Practice Address - Fax:626-577-7458
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36572207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A365720Medicaid
A88385Medicare UPIN
A36572Medicare ID - Type Unspecified