Healthcare Provider Details

I. General information

NPI: 1578016432
Provider Name (Legal Business Name): NORA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST SUITE NUMBER 1204
SILVER SPRING MD
20910-3806
US

IV. Provider business mailing address

8630 FENTON ST SUITE 1204
SILVER SPRING MD
20910-3806
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-7525
  • Fax: 301-495-0318
Mailing address:
  • Phone: 301-340-7525
  • Fax: 301-495-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR154437
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: