Provider Demographics
NPI:1518573153
Name:RODRIGUEZ, CHARITO AGUILAR (LPT)
Entity Type:Individual
Prefix:
First Name:CHARITO
Middle Name:AGUILAR
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4309
Mailing Address - Country:US
Mailing Address - Phone:707-319-6045
Mailing Address - Fax:
Practice Address - Street 1:300 ILENE ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-2631
Practice Address - Country:US
Practice Address - Phone:925-313-7980
Practice Address - Fax:925-646-2060
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33141167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
9222028OtherHEALTH INSURANCE
9222028OtherHEALTH CARD