Provider Demographics
NPI:1922391796
Name:RODRIGUEZ, PAVEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3544
Mailing Address - Country:US
Mailing Address - Phone:210-618-2015
Mailing Address - Fax:
Practice Address - Street 1:27999 MEDICAL CENTER
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:951-365-1841
Practice Address - Fax:949-482-2644
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3047222085N0700X, 2085R0202X
PAMD4590162085N0700X
TXQ14842085R0202X
WI1988-3202085R0202X
CAA1804112085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398414801Medicaid