Basic Information
Provider Information
NPI: 1003153081
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODRIGUEZ
FirstName: ATZIRI
MiddleName:  
NamePrefix: MISS
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 50 MASSOLO DR
Address2: #E
City: PLEASANT HILL
State: CA
PostalCode: 945234834
CountryCode: US
TelephoneNumber: 5105354400
FaxNumber:  
Practice Location
Address1: 3124 INTERNATIONAL BLVD
Address2:  
City: OAKLAND
State: CA
PostalCode: 946012902
CountryCode: US
TelephoneNumber: 5105354400
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/10/2013
LastUpdateDate: 01/10/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
146N00000X  Y Emergency Medical Service ProvidersEmergency Medical Technician, Basic 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

ID Information
IDTypeStateIssuerDescription
HAP11743F01CASOFPOTHER
168986351605CA MEDICAID


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