Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A72787 | CA |
NPI | 1063504447 |
---|---|
Provider Name | Dr. Maritina Solomon Rodriguez |
First Address | Santa Cruz, CA 95065-1719 |
Second Address | Santa Cruz, CA 95065-1719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A727870 | (05) | CA |
DD5840 | MEDICARE RR (01) | CA |
G96519 | (02) | CA |
ZZZ66323Z | BLUE SHIELD PROV. ID (01) | CA |