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NPI Code Detail

MEDICARE: IMMANUEL RODRIGUEZ

MEDICARE: IMMANUEL 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1134542798
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMMANUEL RODRIGUEZ
Provider Business Mailing Address
First Line : 391 W 4800 S
Second Line : APT. 805
City : WASHINGTON TERRACE
State : UT
Zip : 84405-6062
Country : US
Telephone Number : 951-529-6768
Fax Number :
Provider Business Practice Location Address
First Line : 3742 W 4000 S
Second Line :
City : WEST HAVEN
State : UT
Zip : 84401-9630
Country : US
Telephone Number : 801-731-0426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2014
Last Update Date : 01/31/2014

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Directions to “ IMMANUEL RODRIGUEZ ” Practice Location

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