Healthcare Provider Details

I. General information

NPI: 1437700382
Provider Name (Legal Business Name): TINA MARIE RODRIGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA MARIE STOLTZ RN

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

IV. Provider business mailing address

250 N SEE VEE LN
BISHOP CA
93514-8130
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-7611
  • Fax: 760-873-3361
Mailing address:
  • Phone: 760-873-7611
  • Fax: 760-873-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number545780
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: