Healthcare Provider Details

I. General information

NPI: 1972038685
Provider Name (Legal Business Name): ANDRIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 08/06/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W GABILAN ST
SALINAS CA
93901-2762
US

IV. Provider business mailing address

130 W GABILAN ST
SALINAS CA
93901-2762
US

V. Phone/Fax

Practice location:
  • Phone: 831-758-0181
  • Fax:
Mailing address:
  • Phone: 831-771-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: