Provider Demographics
NPI:1700470788
Name:RODRIGUEZ, CANDICE ALLYSHA (RDN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:ALLYSHA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2030
Mailing Address - Country:US
Mailing Address - Phone:530-906-8919
Mailing Address - Fax:
Practice Address - Street 1:1274 SCOTT ST
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2030
Practice Address - Country:US
Practice Address - Phone:530-906-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered