Provider Demographics
NPI:1689318552
Name:RODRIGUEZ, KAITLIN RAYE (DN)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:RAYE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BOTULPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5730
Mailing Address - Country:US
Mailing Address - Phone:505-424-8990
Mailing Address - Fax:505-424-6377
Practice Address - Street 1:2006 BOTULPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5730
Practice Address - Country:US
Practice Address - Phone:505-424-8990
Practice Address - Fax:505-424-6377
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty