MEDICARE: BODY AND SOUL SOVEREIGNTY UNITED

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	363LP1700X	Perinatal Nurse Practitioner

Other Identifiers

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

General Provider Information

NPI Number	:	1790432680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY AND SOUL SOVEREIGNTY UNITED

Provider Business Mailing Address
First Line	:	20655 W LEGEND TRL
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-1756
Country	:	US
Telephone Number	:	833-842-5577
Fax Number	:	833-842-5577

Provider Business Practice Location Address
First Line	:	20655 W LEGEND TRL
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-1756
Country	:	US
Telephone Number	:	833-842-5577
Fax Number	:	833-842-5577

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. LUANA RODRIGUEZ
Credential	:	DNP, CNM, CCTP
Telephone Number	:	833-842-5577

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	03/09/2022

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Directions to “BODY AND SOUL SOVEREIGNTY UNITED ” Practice Location

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