Provider Demographics
NPI:1821684911
Name:RODRIGUEZ, CALLIE (RD, LRD)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD, LRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 SE 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5010
Mailing Address - Country:US
Mailing Address - Phone:507-829-3471
Mailing Address - Fax:
Practice Address - Street 1:1223 ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2180
Practice Address - Country:US
Practice Address - Phone:507-829-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1266133V00000X
ORD-10224515133V00000X
MN4389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered