Provider Demographics
NPI:1912098872
Name:RODRIGUEZ, LEONEL L (MD)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N 1ST ST STE C
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1777
Mailing Address - Country:US
Mailing Address - Phone:760-922-8330
Mailing Address - Fax:760-922-8320
Practice Address - Street 1:205 N 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1777
Practice Address - Country:US
Practice Address - Phone:760-922-8330
Practice Address - Fax:760-922-8320
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A546001Medicaid
CA00A546001Medicaid
G23739Medicare UPIN