Provider Demographics
NPI:1508626003
Name:RODRIGUEZ, MADELEINE OLENKA
Entity Type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:OLENKA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MADELEINE
Other - Middle Name:OLENKA
Other - Last Name:FORONDA FARFAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 IOOF AVE
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5204
Mailing Address - Country:US
Mailing Address - Phone:408-846-2100
Mailing Address - Fax:
Practice Address - Street 1:290 IOOF AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5204
Practice Address - Country:US
Practice Address - Phone:408-846-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator