Provider Demographics
NPI:1043415110
Name:RODRIGUEZ, MARIA D
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23705-0099
Mailing Address - Country:US
Mailing Address - Phone:757-761-6183
Mailing Address - Fax:619-544-7170
Practice Address - Street 1:USNS KANAWHA
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09576-4075
Practice Address - Country:US
Practice Address - Phone:619-544-7171
Practice Address - Fax:619-544-7170
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171000000XOther Service ProvidersMilitary Health Care Provider
Not Answered1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman