Healthcare Provider Details

I. General information

NPI: 1487964797
Provider Name (Legal Business Name): ELIZABETH RODRIGUEZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 07/13/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 120
OXNARD CA
93036-2612
US

IV. Provider business mailing address

2585 PASEO YOLO
CAMARILLO CA
93010-2221
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9270
  • Fax:
Mailing address:
  • Phone: 805-981-9248
  • Fax: 805-981-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number778418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: