=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861213738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALLAS CHRISTIAN RODRIGUEZ DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2024
-----------------------------------------------------
Last Update Date | 10/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 599 S BARRANCA AVE
-----------------------------------------------------
City | COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91723-2777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-894-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 653 AVENIDA BERNARDO
-----------------------------------------------------
City | SAN DIMAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91773-3935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-483-9749
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 305215
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------