Provider Demographics
NPI:1891869657
Name:RODRIGUEZ, GUILLERMO JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 ROCKFIELD BLVD
Mailing Address - Street 2:B220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2720
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:12981 PERRIS BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4102
Practice Address - Country:US
Practice Address - Phone:951-485-6300
Practice Address - Fax:951-485-6322
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29988OtherCHIROPRACTIC LICENSE
CADA128ZOtherINDIVIDUAL PTAN
CA1326291931OtherGROUP NPI
CADA127AOtherGROUP PTAN