Healthcare Provider Details

I. General information

NPI: 1134741671
Provider Name (Legal Business Name): ALEX RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NUIR ROAD
MARTINEZ CA
94553
US

IV. Provider business mailing address

1542 FLAGSHIP DR
VALLEJO CA
94592-1194
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 619-886-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: