MEDICARE: SOPHIA 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
1	237700000X	Hearing Instrument Specialist	HA7605	CA

General Provider Information

NPI Number	:	1619294840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	5912 BOLSA AVE
Second Line	:	STE 201
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-1146
Country	:	US
Telephone Number	:	714-898-5732
Fax Number	:	714-901-4058

Provider Business Practice Location Address
First Line	:	2530 ATLANTIC AVE
Second Line	:	STE D
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2741
Country	:	US
Telephone Number	:	562-426-2137
Fax Number	:	562-426-2512

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

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	05/28/2014

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