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General NPI Number Information
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NPI Number | 1912979204
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Entity Type | Individual
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Provider Name | FAUSTO JOSE RODRIGUEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE RM 18170B
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City | LOS ANGELES
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State | CA
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Zip | 90095-0010
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Country | US
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Telephone | 310-206-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-301-8771
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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 | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | D71393
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | C173820
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 46086
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | C173820
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License Number State | MD
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