Healthcare Provider Details

I. General information

NPI: 1417174988
Provider Name (Legal Business Name): RODRIGO KENNOSUKE CIFUENTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date: 06/23/2024
Reactivation Date: 07/23/2024

III. Provider practice location address

7825 ATLANTIC AVE
CUDAHY CA
90201-5022
US

IV. Provider business mailing address

7825 ATLANTIC AVE
CUDAHY CA
90201-5022
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-6438
  • Fax: 323-562-6595
Mailing address:
  • Phone: 323-562-6438
  • Fax: 323-562-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA89352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: