Provider Demographics
NPI:1922636133
Name:RODRIGUEZ, NATALIE SOLEDAD (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SOLEDAD
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 PARNASSUS AVE # S321
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2205
Mailing Address - Country:US
Mailing Address - Phone:415-476-1239
Mailing Address - Fax:
Practice Address - Street 1:1356 LUSITANA STREET, 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2205
Practice Address - Country:US
Practice Address - Phone:808-586-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
HIMDR-8563208600000X
CAPTL5307208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA98959286FMedicaid