Provider Demographics
NPI:1912993973
Name:RODRIGUEZ, MARTHA LIDIA (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LIDIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 FLORENCE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4015
Mailing Address - Country:US
Mailing Address - Phone:562-928-4642
Mailing Address - Fax:562-928-7511
Practice Address - Street 1:8530 FLORENCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4015
Practice Address - Country:US
Practice Address - Phone:562-928-4642
Practice Address - Fax:562-928-7511
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A800700Medicaid
CAI27145Medicare UPIN
CA00A800700Medicaid