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General NPI Number Information
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NPI Number | 1356761043
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Entity Type | Individual
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Provider Name | JESSICA RODRIGUEZ MS, ATC, CES
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Gender | Female
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 10215 N 43RD AVE
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City | PHOENIX
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State | AZ
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Zip | 85051-1025
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Country | US
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Telephone | 623-810-9408
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 E VAN BUREN ST APT 2064
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City | PHOENIX
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State | AZ
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Zip | 85008-3497
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Country | US
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Telephone | 361-227-0979
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1039
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000006460
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License Number State | TX
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