Provider Demographics
NPI:1912306796
Name:RODRIGUES, NIMMY MARTINA
Entity Type:Individual
Prefix:
First Name:NIMMY
Middle Name:MARTINA
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6826
Mailing Address - Fax:
Practice Address - Street 1:200 C ST
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-2701
Practice Address - Country:US
Practice Address - Phone:209-892-8441
Practice Address - Fax:209-892-5984
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA145019207R00000X
MI4301104802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine