Healthcare Provider Details

I. General information

NPI: 1841972833
Provider Name (Legal Business Name): YAHAIRA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 S 57TH ST
MILWAUKEE WI
53219-3144
US

IV. Provider business mailing address

2773 S 57TH ST
MILWAUKEE WI
53219-3144
US

V. Phone/Fax

Practice location:
  • Phone: 414-510-4341
  • Fax:
Mailing address:
  • Phone: 414-510-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: