Provider Demographics
NPI:1295231777
Name:RODRIGUEZ, ANGEL YVETTE
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:YVETTE
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 1:7748 DREXELBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8263
Mailing Address - Country:US
Mailing Address - Phone:804-709-7448
Mailing Address - Fax:
Practice Address - Street 1:7748 DREXELBROOK RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8263
Practice Address - Country:US
Practice Address - Phone:804-709-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver