Provider Demographics
NPI:1568484863
Name:RODRIGUEZ, ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
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 1:703 MARKET ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2102
Mailing Address - Country:US
Mailing Address - Phone:415-227-4600
Mailing Address - Fax:415-227-4604
Practice Address - Street 1:703 MARKET ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2102
Practice Address - Country:US
Practice Address - Phone:415-227-4600
Practice Address - Fax:415-227-4604
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG388052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry