Healthcare Provider Details

I. General information

NPI: 1780133454
Provider Name (Legal Business Name): ELIZA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 STORY AVE 8 B
BRONX NY
10473-2056
US

IV. Provider business mailing address

2001 STORY AVE 8 B
BRONX NY
10473-2056
US

V. Phone/Fax

Practice location:
  • Phone: 917-544-7240
  • Fax:
Mailing address:
  • Phone: 917-544-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number580604
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number580604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: