MEDICARE: MRS. AMALIA 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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1336220896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMALIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	2826 MICHIGAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-3608
Country	:	US
Telephone Number	:	323-268-9495
Fax Number	:

Provider Business Practice Location Address
First Line	:	2826 MICHIGAN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-3608
Country	:	US
Telephone Number	:	323-268-9495
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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