Provider Demographics
NPI:1710654553
Name:RODRIGUEZ, REBECA SHANTEL (RN)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:SHANTEL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 STATE ST UNIT 316
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6050
Mailing Address - Country:US
Mailing Address - Phone:757-615-8957
Mailing Address - Fax:
Practice Address - Street 1:850 STATE ST UNIT 316
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6050
Practice Address - Country:US
Practice Address - Phone:757-615-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ163224163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator