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NPI Code Detail

MEDICARE: PHYLLIS LOUISE RODRIGUEZ

MEDICARE: PHYLLIS LOUISE 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
1167G00000XLicensed Psychiatric TechnicianPT 35583CA

General Provider Information

NPI Number : 1619370004
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS LOUISE RODRIGUEZ
Provider Business Mailing Address
First Line : 3420 WINTER WAY
Second Line :
City : MADERA
State : CA
Zip : 93637-5956
Country : US
Telephone Number : 559-275-3555
Fax Number :
Provider Business Practice Location Address
First Line : 496 S BARTON AVE
Second Line :
City : FRESNO
State : CA
Zip : 93702-2985
Country : US
Telephone Number : 559-374-3990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2014
Last Update Date : 07/20/2023

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Directions to “ PHYLLIS LOUISE RODRIGUEZ ” Practice Location

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