Basic Information
| Provider Information | |||||||||
| NPI: | 1619294840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | SOPHIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5912 BOLSA AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926491146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148985732 | ||||||||
| FaxNumber: | 7149014058 | ||||||||
| Practice Location | |||||||||
| Address1: | 2530 ATLANTIC AVE | ||||||||
| Address2: | STE D | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908062741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624262137 | ||||||||
| FaxNumber: | 5624262512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2010 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA7605 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.