Healthcare Provider Details

I. General information

NPI: 1023337219
Provider Name (Legal Business Name): WILLOW ANNE RODRIGUEZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CLIPPER ST APT 1
SAN FRANCISCO CA
94114-3634
US

IV. Provider business mailing address

540 CLIPPER ST APT 1
SAN FRANCISCO CA
94114-3634
US

V. Phone/Fax

Practice location:
  • Phone: 415-553-6317
  • Fax:
Mailing address:
  • Phone: 415-553-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number721206
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: