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General NPI Number Information
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NPI Number | 1285888644
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Entity Type | Individual
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Provider Name | RENE RODRIGUEZ PHD, LAC
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Gender | Male
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 05/27/2023
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Provider Practice Location Address
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Address Line | 225 E GRANGER AVE STE 2
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City | MODESTO
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State | CA
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Zip | 95350-4343
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Country | US
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Telephone | 209-353-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 1924 BUR OAK DR
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City | MODESTO
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State | CA
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Zip | 95354-1620
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Country | US
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Telephone | 209-353-4242
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 12601
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License Number State | CA
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