Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A49837 | CA |
Y | 111NI0900X | Internist | A49837 | CA |
N | 207RG0300X | Geriatric Medicine | A49837 | CA |
NPI | 1154320836 |
---|---|
Provider Name | Dr. Rodolfo Baguinguito Protacio |
First Address | Glendale, CA 91204-4647 |
Second Address | Glendale, CA 91204-4647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 07/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A498370 | (05) | CA |
F39006 | (02) | CA |