MEDICARE: MS. RUTH GASSELLE RODRIGUEZ RDN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist
3	174N00000X	Lactation Consultant (Non-RN)
4	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1730677014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH GASSELLE RODRIGUEZ RDN, IBCLC

Provider Business Mailing Address
First Line	:	1020 HUNTINGTON WAY
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571-9438
Country	:	US
Telephone Number	:	951-254-5006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 HUNTINGTON WAY
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92571
Country	:	US
Telephone Number	:	951-254-5006
Fax Number	:

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

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	06/05/2018

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