Individual
ANGEL RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 FRUITVALE AVE, OAKLAND, CA 94601-2322
(510) 535-6200
(510) 535-4167
Mailing address
1601 FRUITVALE AVE, OAKLAND, CA 94601
(510) 535-6200
(510) 535-4167
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FQHC 05-1063
MEDICARE PART A
CA
01
—
FQHC ZZZ29799Z
MEDICARE PART B
CA
Enumeration date
09/07/2007
Last updated
12/24/2007
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