MEDICARE: MRS. MARYBEL RODRIGUEZ GONZALEZ NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	222747	AZ

General Provider Information

NPI Number	:	1093273237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYBEL RODRIGUEZ GONZALEZ NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2400 S AVENUE A
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-7170
Country	:	US
Telephone Number	:	928-344-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 E B ST
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85336-3640
Country	:	US
Telephone Number	:	928-336-2055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	12/05/2024

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