Provider Demographics
NPI:1922288802
Name:RODRIGUEZ, REBECCAH RHENAE (DO)
Entity Type:Individual
Prefix:
First Name:REBECCAH
Middle Name:RHENAE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:8901 ACTIVITY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4436
Mailing Address - Country:US
Mailing Address - Phone:858-793-7860
Mailing Address - Fax:858-436-1289
Practice Address - Street 1:4010 SORRENTO VALLEY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1432
Practice Address - Country:US
Practice Address - Phone:858-793-7860
Practice Address - Fax:858-436-1289
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2020-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4720207Q00000X
CA20A10913207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEB240ZOtherINDIVIDUAL PTAN
CAW12026OtherGROUP PTAN