Provider Demographics
NPI:1861671182
Name:RODRIGUEZ, MAX ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:ENRIQUE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE #340
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-898-1535
Mailing Address - Fax:818-898-9458
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE #340
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-898-1535
Practice Address - Fax:818-898-9458
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2008-08-13
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Provider Licenses
StateLicense IDTaxonomies
CAOOC34500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC34560DMedicare PIN