Healthcare Provider Details

I. General information

NPI: 1609046432
Provider Name (Legal Business Name): CAROLYN LABABIT RODRIGUEZ RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34101 FRAENHOLT AVENUE NAVAL SCHOOL OF HEALTH SCIENCES
SAN DIEGO CA
92134-5291
US

IV. Provider business mailing address

34101 FARENHOLT AVE
SAN DIEGO CA
92134-7000
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7811
  • Fax: 619-532-8189
Mailing address:
  • Phone: 619-532-7811
  • Fax: 619-532-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number323256
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: