Healthcare Provider Details

I. General information

NPI: 1114845286
Provider Name (Legal Business Name): KRYSTAL RODRIGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OVERLAND LOOP STE 201
DAYTON NV
89403-3016
US

IV. Provider business mailing address

720 S MAIN ST STE A
YERINGTON NV
89447-2474
US

V. Phone/Fax

Practice location:
  • Phone: 775-241-9284
  • Fax:
Mailing address:
  • Phone: 775-463-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: