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General NPI Number Information
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NPI Number | 1710837661
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Entity Type | Individual
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Provider Name | GUSTAVO RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 835 ANIRA CT
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City | PERRIS
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State | CA
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Zip | 92571-5113
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Country | US
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Telephone | 951-435-7199
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Fax |
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Provider Business Mailing Address
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Address Line | 22764 AQUEDUCT WAY, MORENO VALLEY, CA, USA
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City | MORENO VALLEY
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State | CA
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Zip | 92553
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Country | US
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Telephone | 213-718-9371
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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