Provider Demographics
NPI:1992372346
Name:RODARTE, ARMANDO (LVN)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:RODARTE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 HARBOR BLVD APT 285
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-8314
Mailing Address - Country:US
Mailing Address - Phone:714-598-7148
Mailing Address - Fax:
Practice Address - Street 1:16425 HARBOR BLVD APT 285
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-8314
Practice Address - Country:US
Practice Address - Phone:714-598-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN293513164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty