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General NPI Number Information
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NPI Number | 1205419512
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Entity Type | Individual
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Provider Name | GUSTAVO ADOLFO RODRIGUEZ FLORES
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Gender | Male
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 405 CENTRAL AVE
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City | NORTHFIELD
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State | IL
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Zip | 60093-3006
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Country | US
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Telephone | 224-505-5431
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 N PINE GROVE AVE APT 307
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City | CHICAGO
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State | IL
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Zip | 60613-4153
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Country | US
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Telephone | 312-731-0148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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