Provider Demographics
NPI:1891948519
Name:RODRIGUEZ, JAMES MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MANUEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 E OCEAN AIR DR
Mailing Address - Street 2:B105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4683
Mailing Address - Country:US
Mailing Address - Phone:858-792-7823
Mailing Address - Fax:858-792-7865
Practice Address - Street 1:11120 E OCEAN AIR DR
Practice Address - Street 2:B105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-4683
Practice Address - Country:US
Practice Address - Phone:858-792-7823
Practice Address - Fax:858-792-7865
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist