MEDICARE: TERESA RODRIGUEZ MSCJHS BSCJHSEM LIC

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	146D00000X	Personal Emergency Response Attendant	4267427	CA

General Provider Information

NPI Number	:	1619672847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA RODRIGUEZ MSCJHS BSCJHSEM LIC

Provider Business Mailing Address
First Line	:	1433 Q AVE APT 9
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-4952
Country	:	US
Telephone Number	:	619-918-3540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 Q AVE APT 9
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-4952
Country	:	US
Telephone Number	:	619-918-3540
Fax Number	:

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

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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