Provider Demographics
NPI:1982104188
Name:RODRIQUEZ, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:RODRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38710 ADCOCK DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4387
Mailing Address - Country:US
Mailing Address - Phone:510-938-8250
Mailing Address - Fax:
Practice Address - Street 1:38710 ADCOCK DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4387
Practice Address - Country:US
Practice Address - Phone:510-938-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer