Provider Demographics
NPI:1861462764
Name:RODRIQUEZ, ERLINDA T (MD)
Entity Type:Individual
Prefix:
First Name:ERLINDA
Middle Name:T
Last Name:RODRIQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6145
Mailing Address - Country:US
Mailing Address - Phone:480-821-7565
Mailing Address - Fax:
Practice Address - Street 1:1717 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6145
Practice Address - Country:US
Practice Address - Phone:480-821-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170720Medicaid
AZWCKHL75Medicare ID - Type Unspecified
AZ170720Medicaid