Healthcare Provider Details

I. General information

NPI: 1538285242
Provider Name (Legal Business Name): MARTIN M RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 S VERMONT AVE SUITE A-200
TORRANCE CA
90502-1029
US

IV. Provider business mailing address

19401 S VERMONT AVE SUITE A-200
TORRANCE CA
90502-1029
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax:
Mailing address:
  • Phone: 310-323-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 8836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: