Provider Demographics
NPI:1750882106
Name:RODRIGUEZ, MYLES I
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:
Last Name:RODRIGUEZ
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3451
Mailing Address - Country:US
Mailing Address - Phone:714-399-3480
Mailing Address - Fax:714-399-3481
Practice Address - Street 1:1855 W KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3451
Practice Address - Country:US
Practice Address - Phone:714-399-3480
Practice Address - Fax:714-399-3481
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist