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NPI Code Detail

MEDICARE: RICHARD RODRIGUEZ

MEDICARE:   RICHARD  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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1275396681
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD RODRIGUEZ
Provider Business Mailing Address
First Line : 7057 GARDEN DR
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-6220
Country : US
Telephone Number : 909-520-8993
Fax Number :
Provider Business Practice Location Address
First Line : 7057 GARDEN DR
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92404-6220
Country : US
Telephone Number : 909-520-8993
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2024
Last Update Date : 01/31/2024

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Directions to “ RICHARD RODRIGUEZ ” Practice Location

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