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General NPI Number Information
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NPI Number | 1356214613
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Entity Type | Individual
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Provider Name | IDALGIS ELIAS RODRIGUEZ MSN-FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 13402 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85032-6047
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Country | US
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Telephone | 602-569-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 6725 W LUKE AVE
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City | GLENDALE
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State | AZ
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Zip | 85303-5413
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Country | US
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Telephone | 786-597-7548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 289258
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License Number State | AZ
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