Healthcare Provider Details

I. General information

NPI: 1285432427
Provider Name (Legal Business Name): ROSEMARIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9161 SIERRA AVE STE 202
FONTANA CA
92335-4773
US

IV. Provider business mailing address

9161 SIERRA AVE STE 202
FONTANA CA
92335-4773
US

V. Phone/Fax

Practice location:
  • Phone: 909-854-3900
  • Fax:
Mailing address:
  • Phone: 909-855-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberA4912274
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberC3658262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: