MEDICARE: VIVIAN ROSARIO 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	363LF0000X	Family Nurse Practitioner	855214	NV
2	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0002163245	OTHER	NV	DL

General Provider Information

NPI Number	:	1487147336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN ROSARIO RODRIGUEZ

Provider Business Mailing Address
First Line	:	417 FOXVALE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-6150
Country	:	US
Telephone Number	:	702-619-1859
Fax Number	:	702-463-0104

Provider Business Practice Location Address
First Line	:	417 FOXVALE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-619-1859
Fax Number	:	702-463-0104

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	02/17/2026

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Directions to “ VIVIAN ROSARIO RODRIGUEZ ” Practice Location

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