Provider Demographics
NPI:1568949188
Name:GARCIA-AGREDANO, RODRIGO I (BA)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:GARCIA-AGREDANO
Suffix:I
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 STOCKDALE HWY STE 2755121
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2656
Mailing Address - Country:US
Mailing Address - Phone:661-427-1567
Mailing Address - Fax:
Practice Address - Street 1:5121 STOCKDALE HWY STE 2755121
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2656
Practice Address - Country:US
Practice Address - Phone:661-427-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker