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NPI Code Detail

MEDICARE: MR. DAVID RODRIGUEZ LCSW

MEDICARE: MR. DAVID RODRIGUEZ LCSW
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
11041C0700XClinical Social WorkerLCSW#5206CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LCSW#5206OTHERCALICENSED CLINICAL SOCIAL

General Provider Information

NPI Number : 1417150095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID RODRIGUEZ LCSW
Provider Business Mailing Address
First Line : 1270 OAK ST
Second Line :
City : UPLAND
State : CA
Zip : 91784-7349
Country : US
Telephone Number : 909-399-3737
Fax Number : 909-399-3750
Provider Business Practice Location Address
First Line : 5330 SAN BERNARDINO ST
Second Line :
City : MONTCLAIR
State : CA
Zip : 91763-2952
Country : US
Telephone Number : 909-399-3737
Fax Number : 909-399-3750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2007
Last Update Date : 07/08/2007

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