Provider Demographics
NPI:1073753687
Name:RODRIGUEZ-DAVEY, MOIRA RUTH (PT)
Entity Type:Individual
Prefix:MRS
First Name:MOIRA
Middle Name:RUTH
Last Name:RODRIGUEZ-DAVEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:319 S MARIPOSA AVE APT 6
Mailing Address - Street 2:LOS ANGELES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2643
Mailing Address - Country:US
Mailing Address - Phone:213-268-6543
Mailing Address - Fax:323-783-4459
Practice Address - Street 1:1526 N EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5260
Practice Address - Country:US
Practice Address - Phone:323-783-1344
Practice Address - Fax:323-783-4459
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist