Provider Demographics
NPI:1851560593
Name:JJ RODRIGUEZ M D INC
Entity Type:Organization
Organization Name:JJ RODRIGUEZ M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-677-7257
Mailing Address - Street 1:32158 CAMINO CAPISTRANO # 411
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3720
Mailing Address - Country:US
Mailing Address - Phone:949-677-7257
Mailing Address - Fax:949-495-1049
Practice Address - Street 1:10921 CHERRY ST
Practice Address - Street 2:100
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2473
Practice Address - Country:US
Practice Address - Phone:562-795-5600
Practice Address - Fax:562-795-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24848Medicare UPIN