Healthcare Provider Details

I. General information

NPI: 1356334320
Provider Name (Legal Business Name): JOYCE M. RODRIGUEZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 29TH ST SUITE 304
OAKLAND CA
94609-3522
US

IV. Provider business mailing address

400 29TH ST SUITE 304
OAKLAND CA
94609-3522
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-4056
  • Fax: 510-832-8507
Mailing address:
  • Phone: 510-832-4056
  • Fax: 510-832-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: