Provider Demographics
NPI:1114280047
Name:RODRIGUEZ, REYNALDINA
Entity Type:Individual
Prefix:
First Name:REYNALDINA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 MUSKOGEE ST
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1462
Mailing Address - Country:US
Mailing Address - Phone:202-704-9675
Mailing Address - Fax:
Practice Address - Street 1:3112 MUSKOGEE ST
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1462
Practice Address - Country:US
Practice Address - Phone:202-704-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR-362-734-025-394374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide