Provider Demographics
NPI:1376106054
Name:RODRIGUEZ, TAYLOR SHEA
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SHEA
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 1:86-123 LEIHOKU ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2986
Mailing Address - Country:US
Mailing Address - Phone:951-227-0424
Mailing Address - Fax:
Practice Address - Street 1:4408 DREXEL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2932
Practice Address - Country:US
Practice Address - Phone:951-227-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95323751163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse