Provider Demographics
NPI:1861058638
Name:RODRIGUEZ, DIANE (LICENSED PHLEBOTOMIS)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LICENSED PHLEBOTOMIS
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED PHLEBOTOMIS
Mailing Address - Street 1:290 MOUNTAUK HWY.
Mailing Address - Street 2:UNIT #286
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955
Mailing Address - Country:US
Mailing Address - Phone:631-800-6441
Mailing Address - Fax:631-503-7826
Practice Address - Street 1:290 MOUNTAUK HWY.
Practice Address - Street 2:UNIT #286
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955
Practice Address - Country:US
Practice Address - Phone:631-800-6441
Practice Address - Fax:631-503-7826
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2025-08-25
Deactivation Date:2020-02-21
Deactivation Code:
Reactivation Date:2025-08-25
Provider Licenses
StateLicense IDTaxonomies
246RM2200X, 251K00000X, 261QX0100X, 246RP1900X
NY81F992374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No251K00000XAgenciesPublic Health or Welfare
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No374700000XNursing Service Related ProvidersTechnician