Healthcare Provider Details

I. General information

NPI: 1184326845
Provider Name (Legal Business Name): MARIO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

7231 BOULDER AVE # 131
HIGHLAND CA
92346-3313
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 888-223-9043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number22-2793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: