Provider Demographics
NPI:1881323244
Name:RODRIGUEZ, AUDREY JORDAN
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:JORDAN
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 EUREKA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2849
Mailing Address - Country:US
Mailing Address - Phone:916-532-0383
Mailing Address - Fax:
Practice Address - Street 1:1520 EUREKA RD STE 102
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2849
Practice Address - Country:US
Practice Address - Phone:916-759-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist