Healthcare Provider Details

I. General information

NPI: 1740942937
Provider Name (Legal Business Name): RUMMY RODRIGUEZ CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 NW ELLAN STREET UITE 2
ROSEBURG OR
97471-8091
US

IV. Provider business mailing address

2958 TUMBLEWOOD GRV
COLORADO SPRINGS CO
80910-4470
US

V. Phone/Fax

Practice location:
  • Phone: 949-514-3658
  • Fax:
Mailing address:
  • Phone: 458-802-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: