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NPI Code Detail

MEDICARE: MS. RUTH GASSELLE RODRIGUEZ RDN, IBCLC

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 License Number License Number State
1133N00000XNutritionist
2133NN1002XNutrition Education Nutritionist
3174N00000XLactation Consultant (Non-RN)
4133V00000XRegistered 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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