Healthcare Provider Details

I. General information

NPI: 1922440965
Provider Name (Legal Business Name): THERESE MARIE RODRIGUEZ R.N. C.F.C.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19615 ENTERPRISE WAY
MONTGOMERY VILLAGE MD
20886-1002
US

IV. Provider business mailing address

19615 ENTERPRISE WAY
MONTGOMERY VILLAGE MD
20886-1002
US

V. Phone/Fax

Practice location:
  • Phone: 301-963-6833
  • Fax:
Mailing address:
  • Phone: 301-963-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberRN59327
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: