Provider Demographics
NPI:1073910196
Name:RODRIGUEZ, YOKASTA NICOLETTE (LMP)
Entity Type:Individual
Prefix:
First Name:YOKASTA
Middle Name:NICOLETTE
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 1:12300 31ST AVE NE
Mailing Address - Street 2:APT 505
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5555
Mailing Address - Country:US
Mailing Address - Phone:206-468-9713
Mailing Address - Fax:
Practice Address - Street 1:8001 14TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4316
Practice Address - Country:US
Practice Address - Phone:206-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60520653225700000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist