Provider Demographics
NPI:1578026654
Name:RODRIGUEZ, ELYNN JANETTE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELYNN
Middle Name:JANETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 CANYON DR APT 11
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3637
Mailing Address - Country:US
Mailing Address - Phone:951-312-7549
Mailing Address - Fax:
Practice Address - Street 1:7220 AVENIDA ENCINAS STE 125
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4689
Practice Address - Country:US
Practice Address - Phone:760-510-6910
Practice Address - Fax:760-510-6911
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist