Healthcare Provider Details

I. General information

NPI: 1184325169
Provider Name (Legal Business Name): CHERYL RODRIGUEZ RRT II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

165 LONGVIEW DR
DALY CITY CA
94015-4721
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-9028
  • Fax:
Mailing address:
  • Phone: 650-393-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number26918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: