Provider Demographics
NPI:1639644677
Name:RODRIGUEZ, ESMERALDA (NP)
Entity Type:Individual
Prefix:MS
First Name:ESMERALDA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 GLENOAKS BLVD SPC 394
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1383
Mailing Address - Country:US
Mailing Address - Phone:661-904-7206
Mailing Address - Fax:
Practice Address - Street 1:12737 GLENOAKS BLVD STE 26
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4776
Practice Address - Country:US
Practice Address - Phone:818-362-1758
Practice Address - Fax:818-362-1779
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty