Healthcare Provider Details

I. General information

NPI: 1285183210
Provider Name (Legal Business Name): MS. REBECCA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 E 38TH ST
LORAIN OH
44055-2810
US

IV. Provider business mailing address

2557 E 38TH ST
LORAIN OH
44055-2810
US

V. Phone/Fax

Practice location:
  • Phone: 440-522-8572
  • Fax:
Mailing address:
  • Phone: 440-522-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: