Provider Demographics
NPI:1396489373
Name:CHARLES RODRIGUEZ, JOCELYN ANDREA
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ANDREA
Last Name:CHARLES 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 1:901 W VICTORIA ST # F&G
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-5807
Mailing Address - Country:US
Mailing Address - Phone:562-519-3245
Mailing Address - Fax:
Practice Address - Street 1:901 W VICTORIA ST # F&G
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5807
Practice Address - Country:US
Practice Address - Phone:562-519-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner