Provider Demographics
NPI:1750988663
Name:RODRIGUEZ, OSCAR IVAN
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:IVAN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11214 126TH AVENUE CT E APT 3
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2332
Mailing Address - Country:US
Mailing Address - Phone:253-254-9158
Mailing Address - Fax:
Practice Address - Street 1:11214 126TH AVENUE CT E APT 3
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2332
Practice Address - Country:US
Practice Address - Phone:253-254-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC13730171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter