Healthcare Provider Details

I. General information

NPI: 1467992040
Provider Name (Legal Business Name): MARGARITA TERESA RODRIGUEZ LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TULLY RD
SAN JOSE CA
95111-1917
US

IV. Provider business mailing address

500 TULLY RD
SAN JOSE CA
95111-1917
US

V. Phone/Fax

Practice location:
  • Phone: 408-817-1303
  • Fax: 408-817-1312
Mailing address:
  • Phone: 408-817-1303
  • Fax: 408-817-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberPT38297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: