Healthcare Provider Details

I. General information

NPI: 1013821610
Provider Name (Legal Business Name): DENICE MARIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 DOVE DR
TRACY CA
95376-8362
US

IV. Provider business mailing address

5319 S PRAIRIE FLOWER RD
TURLOCK CA
95380-9364
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-3312
  • Fax:
Mailing address:
  • Phone: 209-495-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number27875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: