Provider Demographics
NPI:1164697173
Name:PAREDES, GUSTAVO ADOLFO (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ADOLFO
Last Name:PAREDES
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 1:49201 GRAPEFRUIT BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1479
Mailing Address - Country:US
Mailing Address - Phone:760-514-2282
Mailing Address - Fax:
Practice Address - Street 1:49201 GRAPEFRUIT BLVD STE 3
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1479
Practice Address - Country:US
Practice Address - Phone:760-514-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17123208D00000X
CAA112533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice