MEDICARE: ILCE MARGARITA RODRIGUEZ-AVILA M.S. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	27108	CA

General Provider Information

NPI Number	:	1730745662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILCE MARGARITA RODRIGUEZ-AVILA M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	18666 NORTHRIDGE DR
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-1818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 L ST APT A
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5251
Country	:	US
Telephone Number	:	831-585-0152
Fax Number	:

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

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	08/16/2021

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