Provider Demographics
NPI:1922440965
Name:RODRIGUEZ, THERESE MARIE (RN CFCP)
Entity Type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RN CFCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19615 ENTERPRISE WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1002
Mailing Address - Country:US
Mailing Address - Phone:301-963-6833
Mailing Address - Fax:
Practice Address - Street 1:19615 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-1002
Practice Address - Country:US
Practice Address - Phone:301-963-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN59327174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator