Provider Demographics
NPI:1831601145
Name:RODRIGUEZ, CHANEL ELISE (FNP)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:ELISE
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:ELISE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:415-347-8887
Mailing Address - Fax:
Practice Address - Street 1:110 SUTTER ST STE 600
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4020
Practice Address - Country:US
Practice Address - Phone:415-291-0480
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95053133163W00000X
CA95006138363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse