Provider Demographics
NPI:1952974370
Name:RODRIGUEZ, ASHLEY DOMINIQUE
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:DOMINIQUE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:DOMINIQUE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6608 S DATE AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-6619
Mailing Address - Country:US
Mailing Address - Phone:210-919-2091
Mailing Address - Fax:
Practice Address - Street 1:2325 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-712-4301
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator