Provider Demographics
NPI:1093390775
Name:RODRIGUEZ, JOSE A (DNP)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 JONES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4799
Mailing Address - Country:US
Mailing Address - Phone:301-820-0301
Mailing Address - Fax:
Practice Address - Street 1:9051 DUNLOGGIN CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5204
Practice Address - Country:US
Practice Address - Phone:301-820-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142991163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty