Healthcare Provider Details

I. General information

NPI: 1467318394
Provider Name (Legal Business Name): KIMBERLY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W THUNDERBIRD RD
PHOENIX AZ
85023-6399
US

IV. Provider business mailing address

1750 W THUNDERBIRD RD
PHOENIX AZ
85023-6399
US

V. Phone/Fax

Practice location:
  • Phone: 623-915-8903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number325390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: