Provider Demographics
NPI:1134350291
Name:RODRIGUEZ, JAIME ANTONIO (LPN)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:NAPANOCH
Mailing Address - State:NY
Mailing Address - Zip Code:12458-2618
Mailing Address - Country:US
Mailing Address - Phone:845-594-7756
Mailing Address - Fax:845-210-4716
Practice Address - Street 1:11 OLD FARM ROAD
Practice Address - Street 2:
Practice Address - City:NAPANOCH
Practice Address - State:NY
Practice Address - Zip Code:12458
Practice Address - Country:US
Practice Address - Phone:845-594-7756
Practice Address - Fax:845-210-4716
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288387164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse