Provider Demographics
NPI:1255587820
Name:RODRIGUEZ, ANTONIO HURTADO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:HURTADO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:HURTADO
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:630 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3621
Mailing Address - Country:US
Mailing Address - Phone:909-622-3700
Mailing Address - Fax:909-622-3744
Practice Address - Street 1:630 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3621
Practice Address - Country:US
Practice Address - Phone:909-622-3700
Practice Address - Fax:909-622-3744
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109646208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice