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General NPI Number Information
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NPI Number | 1790971851
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Entity Type | Organization
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Legal Business Name | RODOLFO A. DAQUIOAG MD
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 1252 TRAVIS BLVD SUITE D
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City | FAIRFIELD
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State | CA
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Zip | 94533-4886
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Country | US
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Telephone | 707-426-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 1252 TRAVIS BLVD SUITE D
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City | FAIRFIELD
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State | CA
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Zip | 94533-4886
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | RODOLFO A DAQUIOAG
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Credential |
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Telephone | 707-426-4414
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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 | A29896
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License Number State | CA
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