1467694992 NPI number — ARCHIBALD EDMUNDO RODRIGUEZ D.C.

Table of content: ARCHIBALD EDMUNDO RODRIGUEZ D.C. (NPI 1467694992)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467694992 NPI number — ARCHIBALD EDMUNDO RODRIGUEZ D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
ARCHIBALD
Provider Middle Name:
EDMUNDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467694992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 LINDERO CYN. RD.
Provider Second Line Business Mailing Address:
#270
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-497-8581
Provider Business Mailing Address Fax Number:
805-497-8582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 LA VENTA DR.
Provider Second Line Business Practice Location Address:
#205A
Provider Business Practice Location Address City Name:
WEST LAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-497-8581
Provider Business Practice Location Address Fax Number:
805-497-8582
Provider Enumeration Date:
03/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  27637 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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