Individual
SHASTA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 200-2407
Mailing address
300 W MAIN ST, MEDFORD, OR 97501-2756
(541) 200-2407
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
104709
OR
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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