Healthcare Provider Details

I. General information

NPI: 1992482012
Provider Name (Legal Business Name): MRS. MARIA JANET RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 KINROSE CT
COLUMBIA SC
29229-9329
US

IV. Provider business mailing address

15 KINROSE CT
COLUMBIA SC
29229-9329
US

V. Phone/Fax

Practice location:
  • Phone: 803-348-2808
  • Fax:
Mailing address:
  • Phone: 803-348-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: