Healthcare Provider Details

I. General information

NPI: 1134325293
Provider Name (Legal Business Name): THEREZA ESCOTO RODRIUGEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

649 EL PORTAL DR
CHULA VISTA CA
91914-4109
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8865
  • Fax:
Mailing address:
  • Phone: 619-656-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number493008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: