Provider Demographics
NPI:1609851237
Name:RODILES, HORACIO ADALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HORACIO
Middle Name:ADALBERTO
Last Name:RODILES
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 1:9610 GRANITE RIDGE DR
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:2205 ROSS AVE
Practice Address - Street 2:STE 101
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3623
Practice Address - Country:US
Practice Address - Phone:760-353-0404
Practice Address - Fax:760-353-0392
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24654207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A246540Medicaid
CAGJ995ZOtherSOUTHERN CA. PTAN
CAWA24654BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00A246540Medicaid
CAA24654Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER