Provider Demographics
NPI:1184025314
Name:RODRIGUEZ, NATIVIDAD DE MARIA
Entity Type:Individual
Prefix:
First Name:NATIVIDAD
Middle Name:DE MARIA
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 1:50040 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1426
Mailing Address - Country:US
Mailing Address - Phone:760-391-5395
Mailing Address - Fax:
Practice Address - Street 1:50040 HARRISON ST
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1426
Practice Address - Country:US
Practice Address - Phone:760-391-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist