Provider Demographics
NPI:1073619987
Name:RODRIGUEZ, DESIREE PEREZ (PNP)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:PEREZ
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MOTT ST
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2837
Mailing Address - Country:US
Mailing Address - Phone:212-431-3006
Mailing Address - Fax:
Practice Address - Street 1:433 E 100TH ST
Practice Address - Street 2:ROOM 134
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6606
Practice Address - Country:US
Practice Address - Phone:646-672-1454
Practice Address - Fax:212-860-5789
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380986363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics