MEDICARE: JACQUELINE GUADALUPE 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1154949717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE GUADALUPE RODRIGUEZ

Provider Business Mailing Address
First Line	:	7227 COLCHESTER CT # 1-307
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-6781
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7227 COLCHESTER CT # 1-307
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154
Country	:	US
Telephone Number	:	520-427-8660
Fax Number	:

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

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	02/06/2024

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Directions to “ JACQUELINE GUADALUPE RODRIGUEZ ” Practice Location

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