Healthcare Provider Details

I. General information

NPI: 1366389025
Provider Name (Legal Business Name): ILLIANA RODRIGUEZ CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 E 148TH ST
BRONX NY
10455-4041
US

IV. Provider business mailing address

759 SAINT ANNS AVE APT D
BRONX NY
10456-7673
US

V. Phone/Fax

Practice location:
  • Phone: 347-791-2526
  • Fax: 347-791-2526
Mailing address:
  • Phone: 347-791-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberS5N9N5B4
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: