Provider Demographics
NPI:1467586586
Name:RODRIGUEZ, MAGNOLIA
Entity Type:Individual
Prefix:MRS
First Name:MAGNOLIA
Middle Name:
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 1:110 S WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4140
Mailing Address - Country:US
Mailing Address - Phone:626-512-3627
Mailing Address - Fax:
Practice Address - Street 1:110 S WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-4140
Practice Address - Country:US
Practice Address - Phone:626-512-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator