Provider Demographics
NPI:1477869238
Name:RODRIGUEZ, FAUSTO HORACIO (RCP)
Entity type:Individual
Prefix:MR
First Name:FAUSTO
Middle Name:HORACIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 SIMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-5063
Mailing Address - Country:US
Mailing Address - Phone:805-907-2859
Mailing Address - Fax:
Practice Address - Street 1:6803 SIMMONS WAY
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-5063
Practice Address - Country:US
Practice Address - Phone:805-907-2859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000243862278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care