Healthcare Provider Details

I. General information

NPI: 1952993586
Provider Name (Legal Business Name): LORRAINE MARIE RODRIGUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 12/28/2021
Certification Date: 12/16/2021
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

4056 CONRAD DR
SPRING VALLEY CA
91977-1310
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-3648
  • Fax:
Mailing address:
  • Phone: 196-098-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017981
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number831577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: