Provider Demographics
NPI:1518736107
Name:RODRIGUEZ ORTIZ, MARLEEN JANET
Entity Type:Individual
Prefix:
First Name:MARLEEN
Middle Name:JANET
Last Name:RODRIGUEZ ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 90TH ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1807
Mailing Address - Country:US
Mailing Address - Phone:650-573-2630
Mailing Address - Fax:
Practice Address - Street 1:380 90TH ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1807
Practice Address - Country:US
Practice Address - Phone:650-573-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker