Basic Information
| Provider Information | |||||||||
| NPI: | 1295978740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | GUSTAVO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 GULFGATE CENTER MALL | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770873023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014038 | ||||||||
| FaxNumber: | 5124850086 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 MEDICAL PARKWAY, BLDG C, SUITE 150 | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014038 | ||||||||
| FaxNumber: | 5124850086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2009 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Q0552 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.