Healthcare Provider Details

I. General information

NPI: 1558027649
Provider Name (Legal Business Name): CARLOS RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3281 SOLANO AVE
NAPA CA
94558-3202
US

IV. Provider business mailing address

3281 SOLANO AVE
NAPA CA
94558-3202
US

V. Phone/Fax

Practice location:
  • Phone: 707-259-8692
  • Fax:
Mailing address:
  • Phone: 707-259-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: