Provider Demographics
NPI:1730972043
Name:RODRIGUEZ, SAMANTHA (AUD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 MARENGO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1075
Mailing Address - Country:US
Mailing Address - Phone:323-865-4005
Mailing Address - Fax:213-764-2899
Practice Address - Street 1:1640 MARENGO ST STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1075
Practice Address - Country:US
Practice Address - Phone:323-865-4005
Practice Address - Fax:213-764-2899
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist