Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A65512 | CA |
N | 208600000X | Surgeon | A65512 | CA |
N | 208200000X | Surgeon | AFE85512 | CA |
N | 208600000X | Surgeon | AFE85512 | CA |
N | 208200000X | Surgeon | MD166937 | OR |
N | 208600000X | Surgeon | MD166937 | OR |
N | 208200000X | Surgeon | MD60488619 | WA |
N | 208600000X | Surgeon | MD60488619 | WA |
N | 2086S0129X | Vascular Surgeon | A65512 | CA |
N | 2086S0129X | Vascular Surgeon | AFE65512 | CA |
N | 2086S0129X | Vascular Surgeon | MD166937 | OR |
N | 2086S0129X | Vascular Surgeon | MD60488619 | WA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A65512 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | AFE65512 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD166937 | OR |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD60488619 | WA |
NPI | 1114005873 |
---|---|
Provider Name | Dr. Victor M. Rodriguez |
First Address | Sacramento, CA 95817-1418 |
Second Address | Sacramento, CA 95817-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 03/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500670555 | (05) | OR |
G97715 | (02) |