MEDICARE: SHANE 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1528903044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE RODRIGUEZ

Provider Business Mailing Address
First Line	:	685 LUCAS AVE APT 809
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N BULLIS RD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-2209
Country	:	US
Telephone Number	:	310-505-8259
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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Directions to “ SHANE RODRIGUEZ ” Practice Location

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