Provider Demographics
NPI:1073753489
Name:RODRIGUEZ, AURORA (LMP)
Entity Type:Individual
Prefix:MISS
First Name:AURORA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 BORST AVE
Mailing Address - Street 2:C-9
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-2242
Mailing Address - Country:US
Mailing Address - Phone:360-330-5334
Mailing Address - Fax:
Practice Address - Street 1:78 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3036
Practice Address - Country:US
Practice Address - Phone:360-508-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60055760173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60055760OtherLABOR & INDUSTRIES