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NPI Code Detail

MEDICARE: MRS. DANA M. RODRIGUEZ N.P., PHD

MEDICARE: MRS. DANA M. RODRIGUEZ N.P., PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner148732WI
2363LP0200XPediatric Nurse PractitionerAP8704AZ
3363LP0200XPediatric Nurse Practitioner95027907CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003839176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DANA M. RODRIGUEZ N.P., PHD
Provider Business Mailing Address
First Line : 823 GATEWAY CENTER WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4541
Country : US
Telephone Number : 619-515-2300
Fax Number :
Provider Business Practice Location Address
First Line : 4725 MARKET ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4715
Country : US
Telephone Number : 619-515-2560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 03/17/2025

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