Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-128827 | IL |
Y | 2080P0208X | Pediatric Infectious Diseases | 036-128827 | IL |
NPI | 1578785077 |
---|---|
Provider Name | Marcela Rodriguez |
First Address | Springfield, IL 62794-9658 |
Second Address | Springfield, IL 62701-1041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036128827 | (05) | IL |