MEDICARE: JENNIFER 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1982742961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RODRIGUEZ

Provider Business Mailing Address
First Line	:	1828 E 67TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-2117
Country	:	US
Telephone Number	:	323-581-3522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 E 67TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-2117
Country	:	US
Telephone Number	:	323-581-3522
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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