Provider Demographics
NPI:1760035182
Name:RODRIGUEZ, IRMA ALVARADO (RNP)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:ALVARADO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:MRS
Other - First Name:IRMA
Other - Middle Name:A
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNP
Mailing Address - Street 1:714 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3510
Mailing Address - Country:US
Mailing Address - Phone:951-201-0436
Mailing Address - Fax:
Practice Address - Street 1:8112 MILLIKEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7472
Practice Address - Country:US
Practice Address - Phone:909-466-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014283363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA205G1E2KMedicaid