Healthcare Provider Details

I. General information

NPI: 1467373910
Provider Name (Legal Business Name): EDELIN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 K ST
CRESCENT CITY CA
95531-4107
US

IV. Provider business mailing address

455 K ST
CRESCENT CITY CA
95531-4107
US

V. Phone/Fax

Practice location:
  • Phone: 707-465-3663
  • Fax:
Mailing address:
  • Phone: 707-465-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberD9099035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: