Provider Demographics
NPI:1841429115
Name:RODRIGUEZ, RUY
Entity Type:Individual
Prefix:MR
First Name:RUY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18417 NORDHOFF ST STE D
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2276
Mailing Address - Country:US
Mailing Address - Phone:818-734-2761
Mailing Address - Fax:818-734-2762
Practice Address - Street 1:18417 NORDHOFF ST STE D
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2276
Practice Address - Country:US
Practice Address - Phone:818-734-2761
Practice Address - Fax:818-734-2762
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator