Healthcare Provider Details

I. General information

NPI: 1346427275
Provider Name (Legal Business Name): GHISLAINE RODRIGUEZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10474 SANTA MONICA BLVD SUITE 202
LOS ANGELES CA
90025-6929
US

IV. Provider business mailing address

634 SHELDON ST APARTMENT 634
EL SEGUNDO CA
90245-3035
US

V. Phone/Fax

Practice location:
  • Phone: 310-470-2909
  • Fax: 310-470-3286
Mailing address:
  • Phone: 310-647-1979
  • Fax: 310-470-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: