Healthcare Provider Details

I. General information

NPI: 1760035182
Provider Name (Legal Business Name): IRMA ALVARADO RODRIGUEZ RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRMA A RODRIGUEZ RNP

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 MILLIKEN AVE STE 100
RANCHO CUCAMONGA CA
91730-7472
US

IV. Provider business mailing address

714 N GREENWOOD AVE
ONTARIO CA
91764-3510
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-6410
  • Fax:
Mailing address:
  • Phone: 951-201-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014283
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95014283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: