Provider Demographics
NPI:1891712436
Name:RODRIGUEZ, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:10880 WILSHIRE BLVD STE 1800
Mailing Address - Street 2:UCLA DEPT OF FAMILY MEDICINE - OPPENHEIMER TOWER
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4142
Mailing Address - Country:US
Mailing Address - Phone:310-794-0394
Mailing Address - Fax:310-794-6097
Practice Address - Street 1:7515 VAN NUYS BLVD
Practice Address - Street 2:MIDVALLEY HEALTH CENTER
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-947-4095
Practice Address - Fax:818-947-4027
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG68505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46659Medicare UPIN