Provider Demographics
NPI:1194561308
Name:MARTIN RODRIGUEZ, ALVARO (MD)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:MARTIN 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 1:7920 FROST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4289
Mailing Address - Country:US
Mailing Address - Phone:858-966-5840
Mailing Address - Fax:
Practice Address - Street 1:7920 FROST ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4289
Practice Address - Country:US
Practice Address - Phone:858-966-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPTL16777207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program