Provider Demographics
NPI:1245876499
Name:RODRIGUEZ, JARED IGNACIO (NP)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:IGNACIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVE A
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-323-2110
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVE A
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-323-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN185478363LF0000X
AZ235030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN185478OtherAZSBN