Healthcare Provider Details

I. General information

NPI: 1205458726
Provider Name (Legal Business Name): PAULINA RODRIGUEZ
Entity Type: Individual
Gender: Female
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

3975 JACKSON ST STE 209
RIVERSIDE CA
92503-3949
US

IV. Provider business mailing address

3975 JACKSON ST STE 2093975
RIVERSIDE CA
92503-3901
US

V. Phone/Fax

Practice location:
  • Phone: 951-351-2377
  • Fax: 951-351-2378
Mailing address:
  • Phone: 951-351-2377
  • Fax: 951-351-2378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: