MEDICARE: MRS. SOLEDAD LEGARDA 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	2355S0801X	Speech-Language Assistant	SLPA11523	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SLPA11523	OTHER	AZ	SLPA

General Provider Information

NPI Number	:	1619443892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOLEDAD LEGARDA RODRIGUEZ

Provider Business Mailing Address
First Line	:	815 N 52ND ST APT 2219
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7955
Country	:	US
Telephone Number	:	602-315-9946
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N 52ND ST APT 2219
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7955
Country	:	US
Telephone Number	:	602-315-9946
Fax Number	:

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

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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Directions to “ MRS. SOLEDAD LEGARDA RODRIGUEZ ” Practice Location

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