Provider Demographics
NPI:1396393732
Name:RODRIGUEZ, CAROLYN (CAROLYN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CAROLYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11578 E HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-5715
Mailing Address - Country:US
Mailing Address - Phone:480-818-3421
Mailing Address - Fax:
Practice Address - Street 1:11578 E HORSESHOE LN
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-5715
Practice Address - Country:US
Practice Address - Phone:480-818-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician