Healthcare Provider Details

I. General information

NPI: 1649862434
Provider Name (Legal Business Name): DAISY RODRIGUEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 N THOMPSON RD
TIPTON CA
93272-9756
US

IV. Provider business mailing address

4402 E ROOSEVELT CT
VISALIA CA
93292-4407
US

V. Phone/Fax

Practice location:
  • Phone: 559-752-4147
  • Fax:
Mailing address:
  • Phone: 559-631-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: