Healthcare Provider Details

I. General information

NPI: 1336850221
Provider Name (Legal Business Name): MELISSA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17328 W BUCHANAN ST
GOODYEAR AZ
85338-2538
US

IV. Provider business mailing address

17328 W BUCHANAN ST
GOODYEAR AZ
85338-2538
US

V. Phone/Fax

Practice location:
  • Phone: 623-255-8098
  • Fax:
Mailing address:
  • Phone: 602-319-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADE16102
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: