MEDICARE: ALEX PATRICIO 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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1528742400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX PATRICIO RODRIGUEZ

Provider Business Mailing Address
First Line	:	1629 LINDA ROSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-2225
Country	:	US
Telephone Number	:	213-518-1889
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 LINDA ROSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-2225
Country	:	US
Telephone Number	:	213-518-1889
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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