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1184649212

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
1	2084P0800X	Psychiatry Physician	A87906	CA
2	207Q00000X	Family Medicine Physician	A87906	CA
3	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	A87906	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ20041Z	OTHER	CA	MEDICARE CLINIC PTAN
2	W14158	OTHER	CA	MEDICARE 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	:	488 E VALLEY PKWY STE 311
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3374
Country	:	US
Telephone Number	:	760-520-8300
Fax Number	:	760-737-2024

Provider Business Practice Location Address
First Line	:	488 E VALLEY PKWY STE 311
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-3374
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	:	03/15/2026

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Directions to “ GABRIEL RODARTE MD” Practice Location

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