Provider Demographics
NPI:1699887950
Name:RODRIGUEZ, ROSITA NONE (DC)
Entity type:Individual
Prefix:
First Name:ROSITA
Middle Name:NONE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W ROUTE 66
Mailing Address - Street 2:#E
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6202
Mailing Address - Country:US
Mailing Address - Phone:626-650-0300
Mailing Address - Fax:626-650-0300
Practice Address - Street 1:102 W ROUTE 66
Practice Address - Street 2:#E
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6202
Practice Address - Country:US
Practice Address - Phone:626-650-0300
Practice Address - Fax:626-650-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor