Provider Demographics
NPI:1659773281
Name:RODRIGUEZ, NANCY FATIMA
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:FATIMA
Last Name:RODRIGUEZ
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 1:6279 3RD ST APT G
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3129
Mailing Address - Country:US
Mailing Address - Phone:415-336-6544
Mailing Address - Fax:
Practice Address - Street 1:2500 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2109
Practice Address - Country:US
Practice Address - Phone:415-546-6756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA172V00000XOtherCOMMUNITY HEALTH WORKER