Provider Demographics
NPI:1578996278
Name:RODRIGUEZ, ELIESER D (PT)
Entity Type:Individual
Prefix:DR
First Name:ELIESER
Middle Name:D
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12612 SPRINGBROOK DRIVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:703-915-9931
Mailing Address - Fax:
Practice Address - Street 1:12612 SPRINGBROOK DR UNIT A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-5018
Practice Address - Country:US
Practice Address - Phone:703-915-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist