Healthcare Provider Details

I. General information

NPI: 1891937629
Provider Name (Legal Business Name): CAROLEE ANNE RODRIGO CTRS, RTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34400 MISSION BLVD
UNION CITY CA
94587-3604
US

IV. Provider business mailing address

12 MARY LN
EL SOBRANTE CA
94803-2830
US

V. Phone/Fax

Practice location:
  • Phone: 510-429-6440
  • Fax: 510-471-8106
Mailing address:
  • Phone: 510-429-6440
  • Fax: 510-471-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: