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NPI Code Detail

MEDICARE: ANDREA CHRISTINE RODRIGUEZ

MEDICARE: ANDREA CHRISTINE 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1851892814
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA CHRISTINE RODRIGUEZ
Provider Business Mailing Address
First Line : 1135 LAURETO ST
Second Line :
City : MANTECA
State : CA
Zip : 95336-8257
Country : US
Telephone Number : 209-483-8546
Fax Number :
Provider Business Practice Location Address
First Line : 2291 W MARCH LN STE C101
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6669
Country : US
Telephone Number : 916-745-8211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2018
Last Update Date : 02/26/2018

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Directions to “ ANDREA CHRISTINE RODRIGUEZ ” Practice Location

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