Healthcare Provider Details

I. General information

NPI: 1609797745
Provider Name (Legal Business Name): LANCE NICHOLAS RODRIGUEZ R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST STE B
INDIO CA
92201-6950
US

IV. Provider business mailing address

39600 VINELAND ST
CHERRY VALLEY CA
92223-4671
US

V. Phone/Fax

Practice location:
  • Phone: 408-341-9606
  • Fax:
Mailing address:
  • Phone: 909-213-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95133086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: