Provider Demographics
NPI:1932851573
Name:RODRIGUEZ, KANYA ANNETTE
Entity Type:Individual
Prefix:MRS
First Name:KANYA
Middle Name:ANNETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANYA
Other - Middle Name:MUJER
Other - Last Name:ZEPEDA ARREDONDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:286 EUCLID AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3611
Mailing Address - Country:US
Mailing Address - Phone:619-379-6934
Mailing Address - Fax:
Practice Address - Street 1:5473 KEARNY VILLA RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1142
Practice Address - Country:US
Practice Address - Phone:619-379-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist