Provider Demographics
NPI:1619672847
Name:RODRIGUEZ, TERESA (MSCJHS BSCJHSEM LIC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSCJHS BSCJHSEM LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 Q AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4952
Mailing Address - Country:US
Mailing Address - Phone:619-918-3540
Mailing Address - Fax:
Practice Address - Street 1:1433 Q AVE APT 9
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4952
Practice Address - Country:US
Practice Address - Phone:619-918-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4267427146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant