Healthcare Provider Details

I. General information

NPI: 1568641793
Provider Name (Legal Business Name): AMPARO DENISE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST STE.280
SAN JOSE CA
95112-5857
US

IV. Provider business mailing address

3273 VERNICE AVE
SAN JOSE CA
95127-4217
US

V. Phone/Fax

Practice location:
  • Phone: 408-287-6200
  • Fax:
Mailing address:
  • Phone: 408-836-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberASW103298
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: