Healthcare Provider Details

I. General information

NPI: 1124638721
Provider Name (Legal Business Name): MISS PALOMA CIELO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S MADERA AVE SUITE 302, 403, & 404
KERMAN CA
93630-1403
US

IV. Provider business mailing address

275 S MADERA AVE SUITE 302
KERMAN CA
93630-1403
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW116163
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: