Healthcare Provider Details

I. General information

NPI: 1194003285
Provider Name (Legal Business Name): MS. VIRGINIA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N OAKLEY BLVD FL 3 1431 N CLAREMONT
CHICAGO IL
60622-3507
US

IV. Provider business mailing address

6609 S FAIRFIELD AVE
CHICAGO IL
60629-1709
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-3049
  • Fax: 312-770-2557
Mailing address:
  • Phone: 773-209-2035
  • Fax: 312-770-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: