Provider Demographics
NPI:1043573447
Name:DE RODRIGUEZ, ANGELICA LOPEZ
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:LOPEZ
Last Name:DE 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 1:10506 ALLEGRINI DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-0469
Mailing Address - Country:US
Mailing Address - Phone:702-218-8984
Mailing Address - Fax:
Practice Address - Street 1:2770 S MARYLAND PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1566
Practice Address - Country:US
Practice Address - Phone:702-240-3800
Practice Address - Fax:702-240-3001
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant