=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043135585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMARA RODRIGUEZ RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2026
-----------------------------------------------------
Last Update Date | 08/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5715 UTAH TRL
-----------------------------------------------------
City | TWENTYNINE PALMS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92277-6917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-367-9191
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6641 SAN ANGELO AVE
-----------------------------------------------------
City | JOSHUA TREE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92252-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | 95430366
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------