Individual
REBECCAH RHENAE RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4010 SORRENTO VALLEY BLVD, SUITE 300, SAN DIEGO, CA 92121-1432
(858) 793-7860
(858) 436-1289
Mailing address
8901 ACTIVITY RD, STE 100, SAN DIEGO, CA 92126-4436
(858) 793-7860
(858) 436-1289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4720
AZ
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
20A10913
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EB240Z
INDIVIDUAL PTAN
CA
01
—
W12026
GROUP PTAN
CA
Enumeration date
11/08/2007
Last updated
04/10/2020
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