Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 036119039 | IL |
Y | 207N00000X | Dermatologist | 42919 | AZ |
N | 207ND0101X | MOHS-Micrographic Surgeon | 036119039 | IL |
N | 207ND0900X | Dermatopathologist | 036119039 | IL |
N | 207ND0900X | Dermatopathologist | 42919 | AZ |
N | 207NP0225X | Pediatric Dermatologist | 036119039 | IL |
N | 207NS0135X | Procedural Dermatology | 036119039 | IL |
NPI | 1518137306 |
---|---|
Provider Name | Dr. Carlos Frederico Rodriguez |
First Address | Oro Valley, AZ 85737-9465 |
Second Address | Oro Valley, AZ 85737-9465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
867831 | (05) | AZ |
9735166 | AETNA (01) | AZ |
P01291608 | RAILROAD MCR (01) | AZ |