Provider Demographics
NPI:1518043090
Name:RODRIGUEZ, DOROTHY (RN)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:MARIE
Other - Last Name:MANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:3102 OLD BROOKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9339
Mailing Address - Country:US
Mailing Address - Phone:559-772-2356
Mailing Address - Fax:
Practice Address - Street 1:5151 W LAKE RD
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8953
Practice Address - Country:US
Practice Address - Phone:559-772-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670747-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse