Provider Demographics
NPI:1497061667
Name:RODRIGUEZ, YVETTE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 CROSS GATES BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4109
Mailing Address - Country:US
Mailing Address - Phone:985-774-0566
Mailing Address - Fax:
Practice Address - Street 1:895 CROSS GATES BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4109
Practice Address - Country:US
Practice Address - Phone:985-774-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA844716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered