Healthcare Provider Details

I. General information

NPI: 1578144994
Provider Name (Legal Business Name): MRS. VANESSA NICOLE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA NICOLE HERNANDEZ

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W BURBANK BLVD STE M
BURBANK CA
91506-1450
US

IV. Provider business mailing address

606 S EVERETT ST APT B
GLENDALE CA
91205-5322
US

V. Phone/Fax

Practice location:
  • Phone: 800-576-5544
  • Fax:
Mailing address:
  • Phone: 818-573-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: