Healthcare Provider Details

I. General information

NPI: 1548809452
Provider Name (Legal Business Name): MARIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8933 PANAMA RD SUITE 101
LAMONT CA
93241
US

IV. Provider business mailing address

8933 PANAMA RD. STE 101
LAMONT CA
93241
US

V. Phone/Fax

Practice location:
  • Phone: 661-845-3717
  • Fax:
Mailing address:
  • Phone: 661-845-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2872351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: