Basic Information
| Provider Information | |||||||||
| NPI: | 1811629108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | ZARAYA | ||||||||
| MiddleName: | JADE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N CONAHAN DR | ||||||||
| Address2: | |||||||||
| City: | HAZLETON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182017355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705809100 | ||||||||
| FaxNumber: | 5703625112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 EDGE TRL | ||||||||
| Address2: | |||||||||
| City: | SUGARLOAF | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182491017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777243009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2470A2800X | 33431061 | PA | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information | Assistant Record Technician |
No ID Information.