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General NPI Number Information
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NPI Number | 1922922822
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Entity Type | Individual
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Provider Name | ELISA M RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 927 MAIN ST
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City | FORTUNA
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State | CA
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Zip | 95540-2006
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Country | US
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Telephone | 707-362-3857
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Fax |
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Provider Business Mailing Address
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Address Line | 2508 SHAY CT
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City | FORTUNA
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State | CA
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Zip | 95540-2852
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Country | US
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Telephone | 707-740-9176
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 30000813L
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License Number State | CA
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