Provider Demographics
NPI:1740862309
Name:RODRIGUEZ, EVA SERRANO (LVN)
Entity type:Individual
Prefix:MISS
First Name:EVA
Middle Name:SERRANO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MISS
Other - First Name:EVA
Other - Middle Name:SERRANO
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44374 PALM ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3117
Mailing Address - Country:US
Mailing Address - Phone:760-342-6616
Mailing Address - Fax:760-347-8276
Practice Address - Street 1:44374 PALM ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3117
Practice Address - Country:US
Practice Address - Phone:760-342-6616
Practice Address - Fax:760-347-8276
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222127164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse