Healthcare Provider Details

I. General information

NPI: 1154498137
Provider Name (Legal Business Name): ELVA RODRIGUEZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E 142ND ST
BRONX NY
10454-2110
US

IV. Provider business mailing address

545 E 142ND ST
BRONX NY
10454-2110
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-1719
  • Fax:
Mailing address:
  • Phone: 718-579-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF360257-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: