Provider Demographics
NPI:1568908887
Name:RODRIGUEZ, JANNETE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANNETE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 RUGBY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6938
Mailing Address - Country:US
Mailing Address - Phone:323-277-7678
Mailing Address - Fax:323-277-7686
Practice Address - Street 1:6330 RUGBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6938
Practice Address - Country:US
Practice Address - Phone:323-277-7678
Practice Address - Fax:323-277-7686
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024923363LF0000X
CA95078685163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily