Provider Demographics
NPI:1376254342
Name:RODRIGUEZ GARCIA, DIANNETTE MARIE (BA, MS)
Entity Type:Individual
Prefix:
First Name:DIANNETTE
Middle Name:MARIE
Last Name:RODRIGUEZ GARCIA
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6952
Mailing Address - Country:US
Mailing Address - Phone:907-486-9870
Mailing Address - Fax:
Practice Address - Street 1:323 CAROLYN ST
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6376
Practice Address - Country:US
Practice Address - Phone:907-486-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator