Healthcare Provider Details

I. General information

NPI: 1538871017
Provider Name (Legal Business Name): ANTONIO A RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 NEW INDIAN TRAIL CT
AURORA IL
60506-2411
US

IV. Provider business mailing address

1986 W ALGONQUIN RD APT 10A
MT PROSPECT IL
60056-4848
US

V. Phone/Fax

Practice location:
  • Phone: 224-285-3486
  • Fax:
Mailing address:
  • Phone: 224-285-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: