Healthcare Provider Details

I. General information

NPI: 1235609447
Provider Name (Legal Business Name): MAYOLO RODRIGUEZ II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

1560 SAN TOMAS AQUINO RD APT 37
SAN JOSE CA
95130-1138
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-1000
  • Fax:
Mailing address:
  • Phone: 619-382-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number30698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: