Provider Demographics
NPI:1952177859
Name:RODRIGUEZ, ELIAS NOAH
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:NOAH
Last Name:RODRIGUEZ
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 1:504 S BELTLINE BLVD APT C21
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-4264
Mailing Address - Country:US
Mailing Address - Phone:559-361-4224
Mailing Address - Fax:
Practice Address - Street 1:1000 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-2909
Practice Address - Country:US
Practice Address - Phone:559-361-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer