Provider Demographics
NPI:1588670533
Name:RODRIGUEZ, JORGE EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:EDUARDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:393 E WALNUT ST
Mailing Address - Street 2:PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FL
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:11631 VICTORY BLVD
Practice Address - Street 2:#101
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-764-8838
Practice Address - Fax:818-342-2238
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-12-03
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Provider Licenses
StateLicense IDTaxonomies
CAA54207208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics