Healthcare Provider Details

I. General information

NPI: 1023970472
Provider Name (Legal Business Name): LAUREN GRACE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 H ST
EUREKA CA
95501-1026
US

IV. Provider business mailing address

1910 CALIFORNIA ST
EUREKA CA
95501-2899
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9747
  • Fax:
Mailing address:
  • Phone:
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: