Individual
JENNIE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
37 W YOKUTS AVE STE B, STOCKTON, CA 95207-5727
(209) 403-4216
Mailing address
436 COWELL AVE, MANTECA, CA 95336-5908
(209) 403-4216
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LIC-116144
CA
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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