Healthcare Provider Details

I. General information

NPI: 1235211434
Provider Name (Legal Business Name): CARLOS ERICK RODRIGUEZ PT, ATC, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 S HILL ST
LOS ANGELES CA
90007-4119
US

IV. Provider business mailing address

3320 S HILL ST
LOS ANGELES CA
90007-4119
US

V. Phone/Fax

Practice location:
  • Phone: 213-749-5386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: