Provider Demographics
NPI:1245964253
Name:RODRIGUEZ, EVELIO DEJUAN
Entity type:Individual
Prefix:MR
First Name:EVELIO
Middle Name:DEJUAN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 BARKLEY PL
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1156
Mailing Address - Country:US
Mailing Address - Phone:202-844-9216
Mailing Address - Fax:
Practice Address - Street 1:2652 MARTIN LUTHER KING JR AVE SE APT LB7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7707
Practice Address - Country:US
Practice Address - Phone:202-384-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant