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NPI Code Detail

MEDICARE: MR. ANTHONY JOSEPH RODRIGUEZ

MEDICARE: MR. ANTHONY JOSEPH 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
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336633148
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY JOSEPH RODRIGUEZ
Provider Business Mailing Address
First Line : 170 E COLLEGE ST UNIT 4412
Second Line :
City : COVINA
State : CA
Zip : 91723-7030
Country : US
Telephone Number : 310-310-0493
Fax Number :
Provider Business Practice Location Address
First Line : 21600 OXNARD ST STE 1030
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-5085
Country : US
Telephone Number : 877-206-1009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2018
Last Update Date : 08/23/2019

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