Provider Demographics
NPI:1891087201
Name:RODRIGUEZ, STEVEN PAUL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W MONTE VISTA AVE # 123
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-8412
Mailing Address - Country:US
Mailing Address - Phone:626-384-8889
Mailing Address - Fax:
Practice Address - Street 1:1420 CAMERON PARK CT
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-7296
Practice Address - Country:US
Practice Address - Phone:209-324-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224734164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse