Healthcare Provider Details

I. General information

NPI: 1780458612
Provider Name (Legal Business Name): AGUSTIN RODRIGUEZ GONZALEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S E ST
EXETER CA
93221-1731
US

IV. Provider business mailing address

701 W CENTER AVE
VISALIA CA
93291-6015
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-9000
  • Fax: 559-592-9001
Mailing address:
  • Phone: 559-713-6806
  • Fax: 559-713-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305171
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: