Provider Demographics
NPI:1821643297
Name:RODRIGUEZ, NORMA MARCELA
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:MARCELA
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 1:2960 S DURANGO DR STE 112
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4422
Mailing Address - Country:US
Mailing Address - Phone:702-201-2936
Mailing Address - Fax:
Practice Address - Street 1:2960 S DURANGO DR STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4422
Practice Address - Country:US
Practice Address - Phone:702-201-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2005779.081-200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist