Provider Demographics
NPI:1457176554
Name:RODRIGUES, ROSE MARY B (AGACNP)
Entity type:Individual
Prefix:
First Name:ROSE MARY
Middle Name:B
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MRS
Other - First Name:ROSE MARY
Other - Middle Name:B
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGACNP
Mailing Address - Street 1:6268 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2296
Mailing Address - Country:US
Mailing Address - Phone:951-901-3246
Mailing Address - Fax:
Practice Address - Street 1:6268 AUTUMNWOOD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2296
Practice Address - Country:US
Practice Address - Phone:951-901-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031995363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95031995OtherNURSE PRACTITIONER, CALIFORNIA BOARD OF REGISTERED NURSING