Provider Demographics
NPI:1700015732
Name:RODRIGUEZ, RUDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:
Last Name:RODRIGUEZ
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 1:10350 COMMERCE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5863
Mailing Address - Country:US
Mailing Address - Phone:909-476-4455
Mailing Address - Fax:
Practice Address - Street 1:10350 COMMERCE CENTER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5863
Practice Address - Country:US
Practice Address - Phone:909-476-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1263472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry