Provider Demographics
NPI:1093322190
Name:RODRIGUEZ, STEVEN GONZALEZ
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GONZALEZ
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GIBSON DR APT 1612
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5744
Mailing Address - Country:US
Mailing Address - Phone:661-437-1888
Mailing Address - Fax:
Practice Address - Street 1:701 GIBSON DR APT 1612
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5744
Practice Address - Country:US
Practice Address - Phone:661-437-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist