Provider Demographics
NPI:1093272783
Name:RODRIGUEZ, SELENE VERENICE
Entity Type:Individual
Prefix:
First Name:SELENE
Middle Name:VERENICE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17800 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7079
Mailing Address - Country:US
Mailing Address - Phone:562-866-8956
Mailing Address - Fax:
Practice Address - Street 1:17800 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7079
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator