MEDICARE: ERNESTO 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	247200000X	Other Technician	2104708564	NV

General Provider Information

NPI Number	:	1316314529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO RODRIGUEZ

Provider Business Mailing Address
First Line	:	5143 TITANIUM CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1644
Country	:	US
Telephone Number	:	702-409-9043
Fax Number	:

Provider Business Practice Location Address
First Line	:	5143 TITANIUM CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1644
Country	:	US
Telephone Number	:	702-409-9043
Fax Number	:

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

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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Directions to “ ERNESTO RODRIGUEZ ” Practice Location

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