Provider Demographics
NPI:1467924209
Name:OLGUIN, RODRIGO MOISES
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:MOISES
Last Name:OLGUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26510
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6510
Mailing Address - Country:US
Mailing Address - Phone:559-681-2630
Mailing Address - Fax:
Practice Address - Street 1:1959 N GATEWAY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1633
Practice Address - Country:US
Practice Address - Phone:559-681-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100601171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter