Healthcare Provider Details

I. General information

NPI: 1316801525
Provider Name (Legal Business Name): ALLISON RODRIGUEZ CCMA; CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GREAT VALLEY PKWY STE 275
MALVERN PA
19355-1426
US

IV. Provider business mailing address

5 GREAT VALLEY PKWY STE 275
MALVERN PA
19355-1426
US

V. Phone/Fax

Practice location:
  • Phone: 646-589-2182
  • Fax:
Mailing address:
  • Phone: 646-589-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberM6Z6Z7R4
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: