Provider Demographics
NPI:1841322815
Name:RODRIGUEZ-NIETO, JUANA I (RN, DOM)
Entity type:Individual
Prefix:
First Name:JUANA
Middle Name:I
Last Name:RODRIGUEZ-NIETO
Suffix:
Gender:F
Credentials:RN, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 MAEZ RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-3225
Mailing Address - Country:US
Mailing Address - Phone:505-690-1084
Mailing Address - Fax:
Practice Address - Street 1:1161 MAEZ RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3225
Practice Address - Country:US
Practice Address - Phone:505-690-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist