Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 12164 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | RN415092 | CA |
NPI | 1154598704 |
---|---|
Provider Name | Maria Elena Rodriguez |
First Address | San Jose, CA 95126-2203 |
Second Address | Fresno, CA 93728-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 22/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0043790 | (05) | CA |
ZZZ21572Z | GRP PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER MULT LOCATIONS (01) | CA |