Provider Demographics
NPI:1609001999
Name:RODRIGUEZ CLINIC AND FOUNDATION LLC
Entity Type:Organization
Organization Name:RODRIGUEZ CLINIC AND FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-455-2002
Mailing Address - Street 1:4421 CONLIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2154
Mailing Address - Country:US
Mailing Address - Phone:504-455-2002
Mailing Address - Fax:504-885-4383
Practice Address - Street 1:4421 CONLIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2154
Practice Address - Country:US
Practice Address - Phone:504-455-2002
Practice Address - Fax:504-885-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2026602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1075353Medicaid