Healthcare Provider Details

I. General information

NPI: 1598943862
Provider Name (Legal Business Name): STEPHANIE MARIE RODRIGUEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HARRISON ST FL 7
OAKLAND CA
94612-3466
US

IV. Provider business mailing address

616 ANZA ST APT 1
SAN FRANCISCO CA
94118-4329
US

V. Phone/Fax

Practice location:
  • Phone: 510-625-6267
  • Fax:
Mailing address:
  • Phone: 209-969-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: