MEDICARE: MRS. LORI ANN RODRIGUEZ PA

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	363AM0700X	Medical Physician Assistant	PA18174	CA
2	363A00000X	Physician Assistant	PA18174	CA

General Provider Information

NPI Number	:	1902880032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI ANN RODRIGUEZ PA

Provider Business Mailing Address
First Line	:	4214 SAN GIOVANNI CT
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536-2949
Country	:	US
Telephone Number	:	661-917-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	44725 10TH ST W
Second Line	:	# 230
City	:	LANCASTER
State	:	CA
Zip	:	93534-3033
Country	:	US
Telephone Number	:	661-948-1611
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	11/10/2015

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