Basic Information
| Provider Information | |||||||||
| NPI: | 1821544933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | MSN, RN, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6794 S DETROIT CIR | ||||||||
| Address2: | |||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801221820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202897448 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33255 9TH ST | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945872137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104715907 | ||||||||
| FaxNumber: | 5106900703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 95101616 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0200X | 95004771 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.