Provider Demographics
NPI:1528580438
Name:RODRIGUEZ, PERLA MARILYN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:MARILYN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:PERLA
Other - Middle Name:MARILYN
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:38350 40TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3075
Mailing Address - Country:US
Mailing Address - Phone:661-225-3050
Mailing Address - Fax:
Practice Address - Street 1:38350 40TH ST EAST
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550
Practice Address - Country:US
Practice Address - Phone:661-225-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849269163W00000X
CA95014765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse