Healthcare Provider Details

I. General information

NPI: 1457041675
Provider Name (Legal Business Name): SHIRLEY KRISTINE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4044 EAGLE ROCK BLVD
LOS ANGELES CA
90065-3608
US

IV. Provider business mailing address

4044 EAGLE ROCK BLVD
LOS ANGELES CA
90065-3608
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-8642
  • Fax: 323-254-4852
Mailing address:
  • Phone: 323-254-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: