Healthcare Provider Details

I. General information

NPI: 1043415110
Provider Name (Legal Business Name): MARIA D RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNS KANAWHA MEDICAL DEPARTMENT
FPO AE
09576-4075
US

IV. Provider business mailing address

PO BOX 99
PORTSMOUTH VA
23705-0099
US

V. Phone/Fax

Practice location:
  • Phone: 619-544-7171
  • Fax: 619-544-7170
Mailing address:
  • Phone: 757-761-6183
  • Fax: 619-544-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: