Provider Demographics
NPI:1851567101
Name:RODRIGUEZ, GUSTAVO A (BA)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
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 1:2020 ZONAL AVE
Mailing Address - Street 2:RM 215
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-442-6000
Mailing Address - Fax:323-442-6001
Practice Address - Street 1:2020 ZONAL AVE
Practice Address - Street 2:RM 215
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-442-6000
Practice Address - Fax:323-442-6001
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health