Provider Demographics
NPI:1770391781
Name:RODRIGUEZ RODRIGUEZ, KIARA CRISTHY (SA-C)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:CRISTHY
Last Name:RODRIGUEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545 ALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0800
Mailing Address - Country:US
Mailing Address - Phone:951-406-7712
Mailing Address - Fax:
Practice Address - Street 1:11545 ALLWOOD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0800
Practice Address - Country:US
Practice Address - Phone:951-406-7712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23-529246ZC0007X
FLRN9670501163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant