Provider Demographics
NPI:1174040661
Name:RODRIGUEZ, ANTONIA (LVN)
Entity Type:Individual
Prefix:MISS
First Name:ANTONIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8589 S DE LA CRUZ ST
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2128
Mailing Address - Country:US
Mailing Address - Phone:559-477-9605
Mailing Address - Fax:
Practice Address - Street 1:8589 S DE LA CRUZ ST
Practice Address - Street 2:
Practice Address - City:PARLIER
Practice Address - State:CA
Practice Address - Zip Code:93648-2128
Practice Address - Country:US
Practice Address - Phone:559-477-9605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192452164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty