Provider Demographics
NPI:1972986487
Name:RODRIGUEZ, ANGELA MAE (LMP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 W VALLEY HWY N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-1630
Mailing Address - Country:US
Mailing Address - Phone:253-249-4288
Mailing Address - Fax:253-397-4230
Practice Address - Street 1:2002 W VALLEY HWY N
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-1630
Practice Address - Country:US
Practice Address - Phone:253-249-4288
Practice Address - Fax:253-397-4230
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA5508797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist