Provider Demographics
NPI:1831135656
Name:MORALES, RODOLFO ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:ANTONIO
Last Name:MORALES
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 1:3803 S BASCOM AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7319
Mailing Address - Country:US
Mailing Address - Phone:408-559-1018
Mailing Address - Fax:408-371-3025
Practice Address - Street 1:3803 S BASCOM AVE
Practice Address - Street 2:STE 102
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7319
Practice Address - Country:US
Practice Address - Phone:408-559-1018
Practice Address - Fax:408-371-3025
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38251208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HC382510OtherHMO
EC382570OtherCHAMPUS
CA00C382510Medicaid
OOG48808OtherMEDI CAL
PC382510OtherPPO
CA00C382510Medicaid
HC382510OtherHMO