Healthcare Provider Details

I. General information

NPI: 1750104154
Provider Name (Legal Business Name): KIMBERLY KATHERINE RODRIGUEZ I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY KATHERINE RODRIGUEZ

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 RIDER AVE SPC 48
SALINAS CA
93905-1250
US

IV. Provider business mailing address

1280 RIDER AVE SPC 48
SALINAS CA
93905-1250
US

V. Phone/Fax

Practice location:
  • Phone: 831-296-6991
  • Fax:
Mailing address:
  • Phone: 831-296-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: