Provider Demographics
NPI:1316987159
Name:RODRIGUEZ, ESEQUIEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:ESEQUIEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL # 16
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-6195
Mailing Address - Fax:559-353-6196
Practice Address - Street 1:9300 VALLEY CHILDRENS PL # 16
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-6195
Practice Address - Fax:559-353-6196
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80459208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A804590OtherBLUE SHIELD
CAI57364Medicare UPIN
CAWA80459AMedicare ID - Type Unspecified