Healthcare Provider Details

I. General information

NPI: 1992160329
Provider Name (Legal Business Name): PATRICIA RODRIGUEZ, FNP-C & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 JUAN SANCHEZ BLVD SUITE F
SAN LUIS AZ
85349-6805
US

IV. Provider business mailing address

PO BOX 26253
YUMA AZ
85367-1357
US

V. Phone/Fax

Practice location:
  • Phone: 928-550-5641
  • Fax: 928-550-5643
Mailing address:
  • Phone: 928-919-9729
  • Fax: 928-329-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN075667
License Number StateAZ

VIII. Authorized Official

Name: PATRICIA ANN RODRIGUEZ
Title or Position: OWNER
Credential: FNP-C
Phone: 928-318-9600