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NPI Code Detail

MEDICARE: AMANDA MYREA RODRIGUEZ

MEDICARE: AMANDA MYREA RODRIGUEZ
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1265389076
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MYREA RODRIGUEZ
Provider Business Mailing Address
First Line : 2595 ATLANTA AVE SPC 76
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2491
Country : US
Telephone Number : 951-263-0681
Fax Number :
Provider Business Practice Location Address
First Line : 44750 60TH ST W
Second Line :
City : LANCASTER
State : CA
Zip : 93536-7619
Country : US
Telephone Number : 661-729-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ AMANDA MYREA RODRIGUEZ ” Practice Location

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