Healthcare Provider Details

I. General information

NPI: 1992346084
Provider Name (Legal Business Name): IRMA VALERIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 N MAGNOLIA AVE STE 220
SANTEE CA
92071-4516
US

IV. Provider business mailing address

1990 MENENDEZ CT
SAN DIEGO CA
92154-4246
US

V. Phone/Fax

Practice location:
  • Phone: 619-749-7059
  • Fax:
Mailing address:
  • Phone: 619-779-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: