Provider Demographics
NPI:1265581540
Name:RODRIGUEZ, NITZA NINOSKA (DPM)
Entity type:Individual
Prefix:
First Name:NITZA
Middle Name:NINOSKA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6407
Mailing Address - Country:US
Mailing Address - Phone:949-364-9255
Mailing Address - Fax:949-364-9250
Practice Address - Street 1:333 CORPORATE DR STE 230
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2180
Practice Address - Country:US
Practice Address - Phone:949-364-9255
Practice Address - Fax:949-364-9250
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4790213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery