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NPI Code Detail

MEDICARE: SHIRLEY KRISTINE RODRIGUEZ

MEDICARE: SHIRLEY KRISTINE 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
1183700000XPharmacy Technician

General Provider Information

NPI Number : 1457041675
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY KRISTINE RODRIGUEZ
Provider Business Mailing Address
First Line : 4044 EAGLE ROCK BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90065-3608
Country : US
Telephone Number : 323-254-8642
Fax Number :
Provider Business Practice Location Address
First Line : 4044 EAGLE ROCK BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90065-3608
Country : US
Telephone Number : 323-254-8642
Fax Number : 323-254-4852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2023
Last Update Date : 05/10/2023

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Directions to “ SHIRLEY KRISTINE RODRIGUEZ ” Practice Location

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