Provider Demographics
NPI:1922440817
Name:RODRIGUEZ, XIOMARA ALITA (LPN)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:ALITA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LINDEN BLVD
Mailing Address - Street 2:#26B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3311
Mailing Address - Country:US
Mailing Address - Phone:718-536-4572
Mailing Address - Fax:
Practice Address - Street 1:801 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5752
Practice Address - Country:US
Practice Address - Phone:212-316-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309761-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse