Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RS0012X | Sleep Medicine | 26NJ00473100 | NJ |
Y | 363L00000X | Nurse Practitioner | 26NJ00473100 | NJ |
NPI | 1033530753 |
---|---|
Provider Name | Mayra Joselyn Rodriguez |
First Address | Maywood, NJ 07607-1001 |
Second Address | Clifton, NJ 07013-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2013 |
Last Update Date | 16/02/2021 |