Healthcare Provider Details

I. General information

NPI: 1639426067
Provider Name (Legal Business Name): DREAMWEAVER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W LAS TUNAS DR STE 1
SAN GABRIEL CA
91776-1213
US

IV. Provider business mailing address

330 W LAS TUNAS DR STE 1
SAN GABRIEL CA
91776-1213
US

V. Phone/Fax

Practice location:
  • Phone: 626-284-3300
  • Fax: 626-284-3307
Mailing address:
  • Phone: 626-284-3300
  • Fax: 626-284-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: FRANCISCO G RODRIGUEZ
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 626-284-3300