MEDICARE: MARTHA ANGELICA 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1831331206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA ANGELICA RODRIGUEZ

Provider Business Mailing Address
First Line	:	2134 MCGEE AVE
Second Line	:	APT A
City	:	BERKELEY
State	:	CA
Zip	:	94703-1449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2134 MCGEE AVE
Second Line	:	APT A
City	:	BERKELEY
State	:	CA
Zip	:	94703-1449
Country	:	US
Telephone Number	:	510-326-0262
Fax Number	:

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

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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