Gustavo Mario Roldan, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17277 Issued in CA

Practice address

3221 Liberty Blvd
South Gate, CA 90280-2315

Phone

(323) 566-9171

Fax

(323) 566-9178

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Four M Medical Mart a Medical Corporation

  • Occupational Medicine Physician
  • North Hollywood, CA
  • NPI 1447381736
  NPD (past)
• Mahfouz M. Michael,M.D.,Inc.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1093934986
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790720381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 LIBERTY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802315",
            "telephone_number": "323-566-9171",
            "fax_number": "323-566-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 LIBERTY BLVD",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802315",
            "telephone_number": "323-566-9171",
            "fax_number": "323-566-9178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROLDAN",
        "first_name": "GUSTAVO",
        "middle_name": "MARIO",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nidya Rodriguez Alvidrez, LCSW
• Alejandra Rodriguez, MD
• Ashley Melissa Rodriguez
• Nancy Raquel Rodriguez, LMFT
• Rokaya Saad DDS Inc
• Dmitriy Romanenko, M.D.,
• Matthew Alexander Romero
• Ronald H Peltz DPM
• Michelle Rosales
• Rosalind G. Pallivathucal MD Inc.

• Physician Assistant in South Gate, CA
• Providers in South Gate, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.