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General NPI Number Information
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NPI Number | 1114408333
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Entity Type | Individual
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Provider Name | MRS. XIOMARA RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 08/25/2018
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 13911 E AMAR RD UNIT D
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City | LA PUENTE
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State | CA
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Zip | 91746-3600
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Country | US
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Telephone | 626-541-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 637 GREENHORN DR
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1012
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Country | US
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Telephone | 909-655-7120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | D2523937
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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