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NPI Code Detail

MEDICARE: COURTNEY LIN FLORES RODRIGUEZ

MEDICARE: COURTNEY LIN FLORES RODRIGUEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLSW.0009921699CO
21041C0700XClinical Social WorkerLSW.0009921699CO

General Provider Information

NPI Number : 1124504329
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY LIN FLORES RODRIGUEZ
Provider Business Mailing Address
First Line : 1322 SAGITTARIUS ST
Second Line :
City : FRUITA
State : CO
Zip : 81521-3035
Country : US
Telephone Number : 970-640-1664
Fax Number : 970-257-2401
Provider Business Practice Location Address
First Line : 3090 N 12TH ST UNIT A
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-2804
Country : US
Telephone Number : 970-241-2212
Fax Number : 970-257-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2018
Last Update Date : 07/30/2021

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Directions to “ COURTNEY LIN FLORES RODRIGUEZ ” Practice Location

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