Provider Demographics
NPI:1285888644
Name:RODRIGUEZ, RENE (PHD, LAC)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 BUR OAK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1620
Mailing Address - Country:US
Mailing Address - Phone:209-353-4242
Mailing Address - Fax:
Practice Address - Street 1:225 E GRANGER AVE STE 2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4343
Practice Address - Country:US
Practice Address - Phone:209-353-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist