Provider Demographics
NPI:1114090974
Name:RODRIGUEZ, ANITA (L V N)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:L V N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 CEDAR ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6435
Mailing Address - Country:US
Mailing Address - Phone:530-345-1829
Mailing Address - Fax:
Practice Address - Street 1:3510 BRIDLE LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-8748
Practice Address - Country:US
Practice Address - Phone:530-891-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 216351164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN003630Medicaid