Healthcare Provider Details

I. General information

NPI: 1467191726
Provider Name (Legal Business Name): BREANA J RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N CENTRAL AVE UNIT B1
COMPTON CA
90222-1640
US

IV. Provider business mailing address

2600 N COMPTON AVE UNIT B1
COMPTON CA
90222
US

V. Phone/Fax

Practice location:
  • Phone: 888-417-5163
  • Fax:
Mailing address:
  • Phone: 888-417-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: