=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952560641
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERESA CHRISTINE RODRIGUEZ-WARGO MSN PNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2008
-----------------------------------------------------
Last Update Date | 06/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5271 F ST BLDG C
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-733-1412
-----------------------------------------------------
Fax | 916-733-8129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1625 STOCKTON BLVD STE 112
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95816-7098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-262-9136
-----------------------------------------------------
Fax | 916-503-6873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 271680
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------