Healthcare Provider Details

I. General information

NPI: 1962918821
Provider Name (Legal Business Name): CHRISTINA MARIE RODRIGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA MARIE RODRIGUEZ HERRERA RN

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

121 ORANGE AVE SPC 67
CHULA VISTA CA
91911-5138
US

V. Phone/Fax

Practice location:
  • Phone: 304-886-2844
  • Fax:
Mailing address:
  • Phone: 304-886-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number87861
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: