Provider Demographics
NPI:1548809452
Name:RODRIGUEZ, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8933 PANAMA RD.
Mailing Address - Street 2:STE 101
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241
Mailing Address - Country:US
Mailing Address - Phone:661-845-3717
Mailing Address - Fax:
Practice Address - Street 1:8933 PANAMA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241
Practice Address - Country:US
Practice Address - Phone:661-845-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2872351171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator