Provider Demographics
NPI:1003839176
Name:RODRIGUEZ, DANA M (NP, PHD)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP, PHD
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:CIRIACKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, PHD
Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2300
Mailing Address - Fax:
Practice Address - Street 1:4725 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4715
Practice Address - Country:US
Practice Address - Phone:619-515-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148732363L00000X
AZAP8704363LP0200X
CA95027907363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ895196Medicaid