Provider Demographics
NPI:1659178937
Name:RODRIGUEZ, DIANA DELVALLE
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:DELVALLE
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 1:1800 OLD MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1819
Mailing Address - Country:US
Mailing Address - Phone:571-766-6144
Mailing Address - Fax:
Practice Address - Street 1:1800 OLD MEADOW RD
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1819
Practice Address - Country:US
Practice Address - Phone:571-766-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001235267163W00000X, 163WR1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility
Yes163W00000XNursing Service ProvidersRegistered Nurse