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General NPI Number Information
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NPI Number | 1831021062
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Entity Type | Organization
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Legal Business Name | JUVENTUD DERMATOLOGY PLLC
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 140 GAGE BLVD STE 100
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City | RICHLAND
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State | WA
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Zip | 99352-8916
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Country | US
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Telephone | 509-430-8102
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Fax | 509-267-2833
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Provider Business Mailing Address
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Address Line | 1033 SUNHAVEN PL
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City | RICHLAND
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State | WA
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Zip | 99352-9535
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Country | US
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Telephone | 509-430-8102
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Fax | 509-267-2833
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Authorized Official
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Title or Position | NURSE PRACTITONER
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Name | CHRISTINA RODRIGUEZ
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Credential | MSN, NP, FNP-C, DCNP
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Telephone | 509-430-8102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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