Healthcare Provider Details

I. General information

NPI: 1255948998
Provider Name (Legal Business Name): KENIA G MURCIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W PEARL ST
ANAHEIM CA
92801-5941
US

IV. Provider business mailing address

1320 W PEARL ST
ANAHEIM CA
92801-5941
US

V. Phone/Fax

Practice location:
  • Phone: 714-780-1174
  • Fax:
Mailing address:
  • Phone: 714-807-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number749890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: