Provider Demographics
NPI:1982164786
Name:RODRIGUEZ, ELIZABETH RUVALCABA (RDN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUVALCABA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 DURAN CT
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3273
Mailing Address - Country:US
Mailing Address - Phone:408-831-2327
Mailing Address - Fax:408-351-0299
Practice Address - Street 1:641 DURAN CT
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3273
Practice Address - Country:US
Practice Address - Phone:408-831-2327
Practice Address - Fax:408-351-0299
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86025760133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered