MEDICARE: MARIA 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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1922433747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	3750 E BONANZA RD
Second Line	:	UNIT 13 AP.174
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-6422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 E BONANZA RD
Second Line	:	UNIT 13 AP.174
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-6422
Country	:	US
Telephone Number	:	360-831-4606
Fax Number	:

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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Directions to “ MARIA RODRIGUEZ ” Practice Location

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