Provider Demographics
NPI:1942235254
Name:RODRIGUEZ, JUAN ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ROBERTO
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 1:100 WILSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-242-8394
Mailing Address - Fax:
Practice Address - Street 1:559 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4325
Practice Address - Country:US
Practice Address - Phone:831-755-5200
Practice Address - Fax:831-796-3891
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA903442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942235254Medicaid
CA00A903440OtherBS ODF CA
I35924Medicare UPIN
CAGQ000ZMedicare PIN
CA00A903440OtherBS ODF CA
00A903441Medicare PIN
4J763Medicare ID - Type Unspecified
00A903440Medicare PIN
CA1942235254Medicaid