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NPI Code Detail

MEDICARE: JUSTINE LARA RODRIGUEZ CRM

MEDICARE: JUSTINE LARA RODRIGUEZ CRM
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
1175T00000XPeer Specialist24-CRM-3278OR

General Provider Information

NPI Number : 1386487312
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE LARA RODRIGUEZ CRM
Provider Business Mailing Address
First Line : PO BOX 1538
Second Line :
City : NEWPORT
State : OR
Zip : 97365-0115
Country : US
Telephone Number : 541-574-9570
Fax Number : 541-574-8857
Provider Business Practice Location Address
First Line : PO BOX 1538
Second Line :
City : NEWPORT
State : OR
Zip : 97365-0115
Country : US
Telephone Number : 541-574-9570
Fax Number : 541-574-8857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2024
Last Update Date : 06/17/2024

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Directions to “ JUSTINE LARA RODRIGUEZ CRM” Practice Location

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