Provider Demographics
NPI:1205880598
Name:RODRIGUEZ, KRISTIN M (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10279
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0279
Mailing Address - Country:US
Mailing Address - Phone:562-809-3545
Mailing Address - Fax:
Practice Address - Street 1:1301 ROSE DRIVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-993-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6961207P00000X
WAOP61224612207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX69610Medicaid
G84162Medicare UPIN
CA00AX69610Medicaid
CAW20857Medicare PIN
CAW20A6961CMedicare PIN