Healthcare Provider Details

I. General information

NPI: 1740909555
Provider Name (Legal Business Name): MS. DELIA ANN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DELIA ANN RODRIGUEZ D&D MEDICAL INTER LL

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 WILBUR ST
RIVERSIDE CA
92503-5645
US

IV. Provider business mailing address

9825 MAGNOLIA AVE # B198
RIVERSIDE CA
92503-3562
US

V. Phone/Fax

Practice location:
  • Phone: 951-450-9223
  • Fax:
Mailing address:
  • Phone: 951-450-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberC6978164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: