Provider Demographics
NPI:1518556091
Name:RODRIGUEZ, TONYA MAIRE (CNIM)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MAIRE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 DENBY DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3925
Mailing Address - Country:US
Mailing Address - Phone:270-816-7391
Mailing Address - Fax:
Practice Address - Street 1:2485 DENBY DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3925
Practice Address - Country:US
Practice Address - Phone:270-816-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2790OtherCNIM