Provider Demographics
NPI:1669065223
Name:RODRIGUEZ, MADELINE ROSE (DNP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77594 MISSOURI DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8851
Mailing Address - Country:US
Mailing Address - Phone:844-827-8000
Mailing Address - Fax:
Practice Address - Street 1:79200 CORPORATE CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7245
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily