Provider Demographics
NPI:1811189293
Name:RODRIGUEZ, LEO STEVEN (IDC)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:STEVEN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28525 PLANTAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7495
Mailing Address - Country:US
Mailing Address - Phone:951-269-3161
Mailing Address - Fax:
Practice Address - Street 1:BMA SAN NICOLAS IS
Practice Address - Street 2:NAVAL OUTLYING LANDING FIELD
Practice Address - City:POINT MUGU NAWC
Practice Address - State:CA
Practice Address - Zip Code:93042-0001
Practice Address - Country:US
Practice Address - Phone:805-989-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman