Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP60961165 | WA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | RN60326441 | WA |
NPI | 1003471046 |
---|---|
Provider Name | Leticia Rodriguez |
First Address | Yakima, WA 98902-6340 |
Second Address | Yakima, WA 98902-6340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 28/05/2019 |