Individual
CARLOS GUSTAVO RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1403 N FAIR OAKS AVE, SUITE 3, PASADENA, CA 91103-1858
(626) 398-0354
Mailing address
1403 N FAIR OAKS AVE, SUITE 3, PASADENA, CA 91103-1858
(626) 398-0354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A56502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A565020
BLUE CROSS BLUE SHIELD
CA
05
—
00A565020
—
CA
05
—
GR0100500
—
CA
Enumeration date
01/10/2007
Last updated
03/03/2020
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