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General NPI Number Information
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NPI Number | 1265389076
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Entity Type | Individual
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Provider Name | AMANDA MYREA RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 44750 60TH ST W
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City | LANCASTER
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State | CA
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Zip | 93536-7619
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Country | US
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Telephone | 661-729-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2595 ATLANTA AVE SPC 76
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City | RIVERSIDE
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State | CA
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Zip | 92507-2491
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Country | US
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Telephone | 951-263-0681
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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