Provider Demographics
NPI:1235006040
Name:RODRIGUEZ WONG, MARTIN ANDRES
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANDRES
Last Name:RODRIGUEZ WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:34 RONALDO CT
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4239
Mailing Address - Country:US
Mailing Address - Phone:510-599-5295
Mailing Address - Fax:
Practice Address - Street 1:34 RONALDO CT
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4239
Practice Address - Country:US
Practice Address - Phone:510-599-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
226742246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty