Provider Demographics
NPI:1366539793
Name:FERNANDEZ, RODRIGO J (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:J
Last Name:FERNANDEZ
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 1:450 4TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4428
Mailing Address - Country:US
Mailing Address - Phone:619-476-9054
Mailing Address - Fax:619-476-9056
Practice Address - Street 1:450 4TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4428
Practice Address - Country:US
Practice Address - Phone:619-476-9054
Practice Address - Fax:619-476-9056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYTL3179207RN0300X
CAA44441207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444410Medicaid
CAW17207Medicare PIN
CAE48071Medicare UPIN