Provider Demographics
NPI:1588499065
Name:RODRIGUEX, MAXX
Entity type:Individual
Prefix:
First Name:MAXX
Middle Name:
Last Name:RODRIGUEX
Suffix:
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 1:1866 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3483
Mailing Address - Country:US
Mailing Address - Phone:510-935-6211
Mailing Address - Fax:
Practice Address - Street 1:1866 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3483
Practice Address - Country:US
Practice Address - Phone:510-935-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management