MEDICARE: ELOISA MILLAN RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103TF0200X	Forensic Psychologist
2	385HR2055X	Child Mental Illness Respite Care	AZ
3	253J00000X	Foster Care Agency	AZ

General Provider Information

NPI Number	:	1205300365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELOISA MILLAN RODRIGUEZ

Provider Business Mailing Address
First Line	:	3929 W IRWIN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6045
Country	:	US
Telephone Number	:	602-708-7938
Fax Number	:

Provider Business Practice Location Address
First Line	:	3929 W IRWIN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6045
Country	:	US
Telephone Number	:	602-708-7938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	08/27/2025

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