Provider Demographics
NPI:1811629108
Name:RODRIGUEZ, ZARAYA JADE
Entity Type:Individual
Prefix:
First Name:ZARAYA
Middle Name:JADE
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 1:100 N CONAHAN DR
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7355
Mailing Address - Country:US
Mailing Address - Phone:570-580-9100
Mailing Address - Fax:570-362-5112
Practice Address - Street 1:1 EDGE TRL
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-1017
Practice Address - Country:US
Practice Address - Phone:877-724-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA334310612470A2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician