Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 95009648 | CA |
NPI | 1023571221 |
---|---|
Provider Name | Brianna Carol Rodrigues |
First Address | Venice, CA 90291-2581 |
Second Address | Santa Monica, CA 90404-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2019 |
Last Update Date | 13/04/2019 |