Provider Demographics
NPI:1972887420
Name:RODRIGUEZ, NATALIA DOMENIQUE
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:DOMENIQUE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 SUMMERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-6515
Mailing Address - Country:US
Mailing Address - Phone:702-818-9724
Mailing Address - Fax:
Practice Address - Street 1:1210 E BASIN AVE
Practice Address - Street 2:SUTIE 6
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-2101
Practice Address - Country:US
Practice Address - Phone:775-727-6000
Practice Address - Fax:775-727-6013
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0203548912225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner