Provider Demographics
NPI:1720346398
Name:RODRIGUEZ, AMANDA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2110 N BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3126
Mailing Address - Country:US
Mailing Address - Phone:562-346-2222
Mailing Address - Fax:
Practice Address - Street 1:2110 N BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3126
Practice Address - Country:US
Practice Address - Phone:562-346-2222
Practice Address - Fax:562-546-8210
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27721207P00000X
CAC171735207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine