MEDICARE: MA. CECILE ROAN RODRIGUEZ R.N.

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	163W00000X	Registered Nurse	RN57330	NV
2	163W00000X	Registered Nurse	704530	CA
3	163W00000X	Registered Nurse	041.367.440	IL
4	163W00000X	Registered Nurse	RN138126	AZ

General Provider Information

NPI Number	:	1376770784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA. CECILE ROAN RODRIGUEZ R.N.

Provider Business Mailing Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:	APT. # 1127
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:	702-489-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S TOWN CENTER DR
Second Line	:	APT. # 1127
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2064
Country	:	US
Telephone Number	:	702-489-2051
Fax Number	:

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

Provider Enumeration Date	:	06/12/2009
Last Update Date	:	06/12/2009

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