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General NPI Number Information
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NPI Number | 1457573164
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Entity Type | Individual
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Provider Name | CARLOS G. RODRIGUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 965 PLATTE RIVER BLVD UNIT O
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City | BRIGHTON
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State | CO
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Zip | 80601-4353
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Country | US
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Telephone | 303-655-9866
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Fax | 303-655-9869
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Provider Business Mailing Address
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Address Line | 9626 E 147TH PL
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City | BRIGHTON
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State | CO
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Zip | 80602-5758
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Country | US
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Telephone | 303-875-6072
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36368
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License Number State | CO
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