Provider Demographics
NPI:1538380928
Name:RODRIGUEZ, CESAR ALVARO (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:ALVARO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N HACIENDA BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1143
Mailing Address - Country:US
Mailing Address - Phone:626-350-7087
Mailing Address - Fax:626-350-8850
Practice Address - Street 1:1840 N HACIENDA BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1143
Practice Address - Country:US
Practice Address - Phone:626-350-7087
Practice Address - Fax:626-350-8850
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066159208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661590Medicaid
CA00A661590Medicaid