Individual
ALEX RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
790 E BONITA AVE, POMONA, CA 91767-1906
(909) 625-7207
Mailing address
1794 W SUMMIT ST, RIALTO, CA 92377-3755
(909) 510-3604
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TRIA121
MIS NUMBER
CA
Enumeration date
02/14/2007
Last updated
01/31/2008
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