MEDICARE: MALIA WOOD- RODRIGUEZ

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61488671	WA

General Provider Information

NPI Number	:	1215792619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIA WOOD- RODRIGUEZ

Provider Business Mailing Address
First Line	:	22207 7TH AVE S
Second Line	:
City	:	DES MOINES
State	:	WA
Zip	:	98198-6221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22207 7TH AVE S
Second Line	:
City	:	DES MOINES
State	:	WA
Zip	:	98198-6221
Country	:	US
Telephone Number	:	206-588-5251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	03/17/2024

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Directions to “ MALIA WOOD- RODRIGUEZ ” Practice Location

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