Provider Demographics
NPI:1972600880
Name:RODRIGUEZ, MIGUEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EASTSIDE
Other - Middle Name:
Other - Last Name:DIABETES CLINIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5836 E BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022
Mailing Address - Country:US
Mailing Address - Phone:323-726-0370
Mailing Address - Fax:323-726-0239
Practice Address - Street 1:5836 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022
Practice Address - Country:US
Practice Address - Phone:323-726-0370
Practice Address - Fax:323-726-0239
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33652207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A336520Medicaid
C35421Medicare UPIN
CAA33652Medicare ID - Type Unspecified