Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 20891 | CA |
Y | 2251C2600X | Cardiopulmonary | 20891 | CA |
NPI | 1437535135 |
---|---|
Provider Name | Jeff Rodrigues |
First Address | Long Beach, CA 90840-0004 |
Second Address | Long Beach, CA 90840-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 04/08/2015 |