Healthcare Provider Details

I. General information

NPI: 1659363166
Provider Name (Legal Business Name): LUANA RODRIGUEZ DNP, CNM, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20655 W LEGEND TRL
BUCKEYE AZ
85396-1756
US

IV. Provider business mailing address

20655 W LEGEND TRL
BUCKEYE AZ
85396-1756
US

V. Phone/Fax

Practice location:
  • Phone: 954-682-7069
  • Fax:
Mailing address:
  • Phone: 954-682-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN151992
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9178401
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP3016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: