Healthcare Provider Details

I. General information

NPI: 1043102130
Provider Name (Legal Business Name): RONNIE S RODRIGUEZ CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 SW EMIGRANT AVE
PENDLETON OR
97801-1838
US

IV. Provider business mailing address

PO BOX 882
PENDLETON OR
97801-0882
US

V. Phone/Fax

Practice location:
  • Phone: 541-215-8798
  • Fax:
Mailing address:
  • Phone: 541-663-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number24-CRM-3803
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: