Healthcare Provider Details

I. General information

NPI: 1134059611
Provider Name (Legal Business Name): MRS. KIMBERLY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E BROADWAY RD
TEMPE AZ
85282-1612
US

IV. Provider business mailing address

305 W MESQUITE ST
CHANDLER AZ
85225-2663
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number241963
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: