Provider Demographics
NPI:1649029018
Name:RODRIGUEZ, MARIZA
Entity type:Individual
Prefix:
First Name:MARIZA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 STATE ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548-5212
Mailing Address - Country:US
Mailing Address - Phone:704-996-2717
Mailing Address - Fax:
Practice Address - Street 1:2186 STATE ROUTE 32
Practice Address - Street 2:
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548-5212
Practice Address - Country:US
Practice Address - Phone:704-996-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula