Provider Demographics
NPI:1023192663
Name:ALBAN, RODRIGO F (MD)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:F
Last Name:ALBAN
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 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 650W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-423-8513
Mailing Address - Fax:310-248-8594
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 650W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-423-8513
Practice Address - Fax:310-248-8594
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2294232086S0102X
CAA92657208600000X, 2086S0127X, 2086S0102X
FLME1068642086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH274ZMedicare PIN
FLDH274YMedicare PIN