Healthcare Provider Details

I. General information

NPI: 1992667877
Provider Name (Legal Business Name): MAURA RODRIGUEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

6623 SEVILLA PL
RANCHO CUCAMONGA CA
91739-1504
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-5555
  • Fax:
Mailing address:
  • Phone: 562-745-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95031661
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: