Basic Information
| Provider Information | |||||||||
| NPI: | 1245697549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | YESENIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9570 CENTER AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917305842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099802789 | ||||||||
| FaxNumber: | 9099802689 | ||||||||
| Practice Location | |||||||||
| Address1: | 9570 CENTER AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917305842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099802788 | ||||||||
| FaxNumber: | 9099802689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.