Provider Demographics
NPI:1568462109
Name:COMUNALE, RODERICK A II (MD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:A
Last Name:COMUNALE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RODERICK
Other - Middle Name:
Other - Last Name:COMUNALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-1188
Mailing Address - Country:US
Mailing Address - Phone:858-551-0276
Mailing Address - Fax:858-454-8796
Practice Address - Street 1:502 EUCLID AVE STE 205
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2993
Practice Address - Country:US
Practice Address - Phone:858-551-0276
Practice Address - Fax:858-454-8796
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2024-02-01
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
CAA43885207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A438850Medicaid
CAA43885OtherMEDICARE
CA00A438851Medicaid
CAA43885AOtherMEDICARE
E93200Medicare UPIN