Doctor Name: | BENITO B RODRIGUEZ |
NPI Number: | 1124064183 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA C |
License Number: | 232 |
Business Practice Address: | 14502 W Meeker Blvd Sun City West, AZ - 853755282 |
Business Phone Number: | 6232144000 |
Business Fax Number: | 6232144000 |
Mailing Address: | 2100 Powell St Ste 900, EMERYVILLE |
State: | CA |
Postal Code: | 946081844 |
Phone Number: | 5103502698 |
Fax Number: | 5108799084 |
NPI Enumeration Date: | 06/20/2006 |
NPI Last Update Date: | 11/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 232 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |