Provider Demographics
NPI:1952560641
Name:RODRIGUEZ-WARGO, TERESA CHRISTINE (MSN PNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:CHRISTINE
Last Name:RODRIGUEZ-WARGO
Suffix:
Gender:F
Credentials:MSN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1625 STOCKTON BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7098
Mailing Address - Country:US
Mailing Address - Phone:916-262-9136
Mailing Address - Fax:916-503-6873
Practice Address - Street 1:5271 F ST BLDG C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3225
Practice Address - Country:US
Practice Address - Phone:916-733-1412
Practice Address - Fax:916-733-8129
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA271680363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics