Provider Demographics
NPI:1205458726
Name:RODRIGUEZ, PAULINA
Entity type:Individual
Prefix:
First Name:PAULINA
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 1:3975 JACKSON ST STE 2093975
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3901
Mailing Address - Country:US
Mailing Address - Phone:951-351-2377
Mailing Address - Fax:951-351-2378
Practice Address - Street 1:3975 JACKSON ST STE 209
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3949
Practice Address - Country:US
Practice Address - Phone:951-351-2377
Practice Address - Fax:951-351-2378
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83032225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist