Healthcare Provider Details

I. General information

NPI: 1902321607
Provider Name (Legal Business Name): MARCOS RODRIGUEZ II FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S WESTERN AVE
OKLAHOMA CITY OK
73109-3413
US

IV. Provider business mailing address

4329 SE 56TH CIR
OKLAHOMA CITY OK
73135-2503
US

V. Phone/Fax

Practice location:
  • Phone: 405-636-7500
  • Fax:
Mailing address:
  • Phone: 14056094361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR83620
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR83620
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: