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NPI Code Detail

MEDICARE: GABRIEL RODARTE MD

MEDICARE: GABRIEL RODARTE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA87906CA
2207Q00000XFamily Medicine PhysicianA87906CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ20041ZOTHERCAMEDICARE CLINIC PTAN
2W14158OTHERCAMEDICARE CLINIC PTAN

General Provider Information

NPI Number : 1184649212
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIEL RODARTE MD
Provider Business Mailing Address
First Line : 425 N DATE ST
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-3413
Country : US
Telephone Number : 760-520-8300
Fax Number : 760-737-2024
Provider Business Practice Location Address
First Line : 425 N DATE ST
Second Line : #203
City : ESCONDIDO
State : CA
Zip : 92025-3413
Country : US
Telephone Number : 760-520-8340
Fax Number : 760-839-9459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 03/28/2012

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