Healthcare Provider Details

I. General information

NPI: 1114629391
Provider Name (Legal Business Name): JOSEPHINE ESPERANZA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 SEPULVEDA BLVD
TORRANCE CA
90505-2408
US

IV. Provider business mailing address

323 W 223RD ST
CARSON CA
90745-3631
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-5884
  • Fax:
Mailing address:
  • Phone: 310-745-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number147168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: