=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922720127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL OSVALDO RODRIGUEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2022
-----------------------------------------------------
Last Update Date | 06/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S RANCHO DR STE A10
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-4898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-437-4673
-----------------------------------------------------
Fax | 702-438-4673
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 S RANCHO DR STE A10
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89106-4898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-437-4673
-----------------------------------------------------
Fax | 702-438-4673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | IC-2442
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------