Healthcare Provider Details

I. General information

NPI: 1447047956
Provider Name (Legal Business Name): NOEL ANN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 6TH ST
SANTA ROSA CA
95401-6270
US

IV. Provider business mailing address

983 SONOMA AVE
SANTA ROSA CA
95404-4818
US

V. Phone/Fax

Practice location:
  • Phone: 707-308-4727
  • Fax:
Mailing address:
  • Phone: 707-308-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: