Provider Demographics
NPI:1144263682
Name:RODRIGUEZ, FERNANDO (DC)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SEPULVEDA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-3323
Mailing Address - Country:US
Mailing Address - Phone:818-612-8229
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3323
Practice Address - Country:US
Practice Address - Phone:818-612-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08977Medicare UPIN