Healthcare Provider Details

I. General information

NPI: 1306404082
Provider Name (Legal Business Name): STEVEN RODRIGUEZ CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PLAZA DR STE 100
BLANDON PA
19510-9454
US

IV. Provider business mailing address

2500 BERNVILLE RD
READING PA
19605-9453
US

V. Phone/Fax

Practice location:
  • Phone: 610-208-4650
  • Fax: 610-916-2787
Mailing address:
  • Phone: 610-378-2000
  • Fax: 610-378-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020398
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: