Provider Demographics
NPI:1962477067
Name:RODRIGUEZ, HECTOR F (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:F
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:PO BOX 3129
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3129
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:400 S SEPULVEDA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6876
Practice Address - Country:US
Practice Address - Phone:310-546-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11629207L00000X
CAA92346207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1962477067Medicaid
GA220301203AMedicaid
NV100507156Medicaid
ID807890400Medicaid
AZ968422Medicaid
I43169Medicare UPIN
NV101461Medicare PIN
IL1962477067Medicaid