Healthcare Provider Details

I. General information

NPI: 1720308927
Provider Name (Legal Business Name): PATRICIA ANN RODRIGUEZ PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 VAN NUYS BLVD
VAN NUYS CA
91405-3005
US

IV. Provider business mailing address

11369 MICHELLE ST
CERRITOS CA
90703-5561
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-1388
  • Fax:
Mailing address:
  • Phone: 562-754-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number618333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: