Basic Information
| Provider Information | |||||||||
| NPI: | 1720589625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | FATIMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 S MARYLAND PKWY STE 1 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891043225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026853418 | ||||||||
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| Address1: | 2100 S MARYLAND PKWY STE 1 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891043225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026010066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2018 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | N | Nursing Service Related Providers | Technician | Personal Care Attendant | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.