Healthcare Provider Details

I. General information

NPI: 1164158804
Provider Name (Legal Business Name): NOELIA CECILIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

IV. Provider business mailing address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

V. Phone/Fax

Practice location:
  • Phone: 916-907-3208
  • Fax:
Mailing address:
  • Phone: 916-907-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: