Provider Demographics
NPI:1669181509
Name:RODRIGUEZ, MANUEL JR (RDN)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:RDN
Other - Prefix:MR
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RDN,
Mailing Address - Street 1:123 S FIGUEROA ST APT 640
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-5436
Mailing Address - Country:US
Mailing Address - Phone:562-967-9644
Mailing Address - Fax:
Practice Address - Street 1:123 S FIGUEROA ST APT 640
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-5436
Practice Address - Country:US
Practice Address - Phone:562-967-9644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered