Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 33517 | CA |
N | 111NP0017X | Pediatric Chiropractor | 33517 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 33517 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | 33517 | CA |
NPI | 1649706425 |
---|---|
Provider Name | Edgar Rodriguez |
First Address | Pico Rivera, CA 90660-1940 |
Second Address | Pico Rivera, CA 90660-1940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |