Provider Demographics
NPI:1689086399
Name:DAVID HERNANDEZ- RODRIGUEZ M.D. INC.
Entity Type:Organization
Organization Name:DAVID HERNANDEZ- RODRIGUEZ M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ - RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-245-6925
Mailing Address - Street 1:14829 SEVENTH ST STE D
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4009
Mailing Address - Country:US
Mailing Address - Phone:760-245-6925
Mailing Address - Fax:760-243-6251
Practice Address - Street 1:14829 SEVENTH ST STE D
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4009
Practice Address - Country:US
Practice Address - Phone:760-245-6925
Practice Address - Fax:760-243-6251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty