Healthcare Provider Details

I. General information

NPI: 1497129738
Provider Name (Legal Business Name): JAZMINE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 VALLEY BLVD SUITE A
EL MONTE CA
91731-3600
US

IV. Provider business mailing address

17002 E ALCROSS ST
COVINA CA
91722-1204
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-1600
  • Fax: 626-258-1609
Mailing address:
  • Phone: 626-922-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11604
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: