Basic Information
| Provider Information | |||||||||
| NPI: | 1265071682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ-HAYWOOD | ||||||||
| FirstName: | JENEA | ||||||||
| MiddleName: | ROCHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15095 AMARGOSA RD # SUIET208 | ||||||||
| Address2: | |||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923941879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602454695 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1950 S SUNWEST LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092524017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2020 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.