Provider Demographics
NPI:1487832879
Name:RODRIGUEZ, BEATRIZ J (PHN)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1341
Mailing Address - Country:US
Mailing Address - Phone:650-573-2264
Mailing Address - Fax:650-341-0674
Practice Address - Street 1:150 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1341
Practice Address - Country:US
Practice Address - Phone:650-573-2264
Practice Address - Fax:650-341-0674
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425827376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator