Provider Demographics
NPI:1548252836
Name:RODRIGUEZ, ROBERTO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:LUIS
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 1:10775 PIONEER TRL STE 215
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0234
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155078208000000X
GA93641208000000X
AZ65186208000000X
CAA88020208000000X
HIMD-22303208000000X
MO2022002034208000000X
WAMD61238004208000000X
NV21793208000000X
PAMD421935208000000X
CODR.0067576208000000X
TXM3717208000000X
MDD95328208000000X
IL036158875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002472Medicaid
TX181402206Medicaid
MO830105662Medicaid
NV250016795Medicaid
CA100241921Medicaid
WA2200757Medicaid
CO9000199578Medicaid
AZ106158Medicaid