Provider Demographics
NPI:1831526953
Name:RODRIGUEZ, KATHRYN V (RD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:V
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:V
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:955 W IMPERIAL HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3812
Mailing Address - Country:US
Mailing Address - Phone:714-618-9500
Mailing Address - Fax:
Practice Address - Street 1:4699 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2526
Practice Address - Country:US
Practice Address - Phone:949-557-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1006544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered