Healthcare Provider Details

I. General information

NPI: 1326611872
Provider Name (Legal Business Name): DIANA MARIE RODRIGUEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 12/28/2023
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 632572
CINCINNATI OH
45263-2572
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2432
  • Fax:
Mailing address:
  • Phone: 513-222-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.414310
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number414310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: