MEDICARE: ANGELI P 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
1	171400000X	Health & Wellness Coach		TX

General Provider Information

NPI Number	:	1124715479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELI P RODRIGUEZ

Provider Business Mailing Address
First Line	:	1720 WHITTENBURG DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3314
Country	:	US
Telephone Number	:	817-689-9810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 WHITTENBURG DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-3314
Country	:	US
Telephone Number	:	817-689-9810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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Directions to “ ANGELI P RODRIGUEZ ” Practice Location

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