Individual provider Active NPI

Rosa Denisse Rodriguez, M.D.

  • Developmental - Behavioral Pediatrics Physician
  • Sacramento, CA
National Provider Identifier
1255736476
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
A149935 Issued in CA
Practice address
2825 50TH St
Sacramento, CA 95817-2310
Phone
(916) 703-0279
Fax
(916) 703-0243
NPI assigned
Oct 30, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A149935 CA
General Acute Care Hospital 282N00000X
Student in an Organized Health Care Education/Training Program 390200000X
Developmental - Behavioral Pediatrics Physician 2080P0006X A149935 CA Primary

Addresses

Primary practice location

2825 50TH St
Sacramento, CA 95817-2310

Mailing address

2825 50TH St RM 2333
Sacramento, CA 95817-2310
Phone (916) 734-0279

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201130002568 CA Practitioner - Pediatric Medicine 9436449857 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A149935CAMDDevelopmental - Behavioral Pediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Sacramento CurrentSince Apr 1, 2021 Accepting new patients
County of Sacramento CurrentSince Apr 1, 2021 Accepting new patients
Regents of the Univ of Ca CurrentSince Nov 9, 2020 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the University of Ca Pediatrics CurrentSince Nov 9, 2020 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

2825 50th St
Rm 2333
Sacramento, CA 95817

2825 50th St
Sacramento, CA 95817
Phone (916) 703-0300

4600 Broadway
Sacramento, CA 95820
Phone (916) 874-9670

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

4600 Broadway
#1100
Sacramento, CA 95820
Phone (916) 874-9670

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1255736476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 50TH ST RM 2333",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172310",
            "telephone_number": "916-734-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 50TH ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172310",
            "telephone_number": "916-703-0279",
            "fax_number": "916-703-0243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "ROSA",
        "middle_name": "DENISSE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-30",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A149935",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "A149935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.