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General NPI Number Information
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NPI Number | 1083868624
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Entity Type | Organization
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Legal Business Name | LUIS M RODRIGUEZ
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/10/2008
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Provider Practice Location Address
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Address Line | 420 N MCKINLEY ST SUIE 111-356
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City | CORONA
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State | CA
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Zip | 92879-8099
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Country | US
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Telephone | 951-454-7314
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Fax |
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Provider Business Mailing Address
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Address Line | 420 N MCKINLEY ST SUIE 111-356
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City | CORONA
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State | CA
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Zip | 92879-8099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUIS M RODRIGUEZ
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Credential |
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Telephone | 951-454-7314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 05D1090908
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License Number State | CA
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