Healthcare Provider Details

I. General information

NPI: 1780925859
Provider Name (Legal Business Name): NADIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 POMONA BLVD
LOS ANGELES CA
90022-1717
US

IV. Provider business mailing address

5420 POMONA BLVD
LOS ANGELES CA
90022-1717
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-0411
  • Fax: 323-890-8761
Mailing address:
  • Phone: 323-728-0411
  • Fax: 323-890-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: