Basic Information
| Provider Information | |||||||||
| NPI: | 1871791103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 112TH ST SW | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982044875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255516200 | ||||||||
| FaxNumber: | 4255516017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1019 112TH ST SW | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982044875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255516200 | ||||||||
| FaxNumber: | 4255516017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2007 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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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 | 207Q00000X | MD60153592 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.