Provider Demographics
NPI:1972684744
Name:RODRIGUEZ, ELIAS JR (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:DR
Other - First Name:ELIAS
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2331
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-0331
Mailing Address - Country:US
Mailing Address - Phone:562-940-6077
Mailing Address - Fax:562-803-0637
Practice Address - Street 1:7285 QUILL DR
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2001
Practice Address - Country:US
Practice Address - Phone:562-940-6077
Practice Address - Fax:562-803-0637
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0667832084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry