Healthcare Provider Details

I. General information

NPI: 1831331206
Provider Name (Legal Business Name): MARTHA ANGELICA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2134 MCGEE AVE APT A
BERKELEY CA
94703-1449
US

IV. Provider business mailing address

2134 MCGEE AVE APT A
BERKELEY CA
94703-1449
US

V. Phone/Fax

Practice location:
  • Phone: 510-326-0262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: