MEDICARE: ERICKA M 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	101YM0800X	Mental Health Counselor
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1306555842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA M RODRIGUEZ

Provider Business Mailing Address
First Line	:	10 CARR ST
Second Line	:
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-4710
Country	:	US
Telephone Number	:	831-425-8132
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 17TH AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1804
Country	:	US
Telephone Number	:	831-425-8132
Fax Number	:

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

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	06/27/2023

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Directions to “ ERICKA M RODRIGUEZ ” Practice Location

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