Provider Demographics
NPI:1073368148
Name:RIDRIGUEZ, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:RIDRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2625
Mailing Address - Country:US
Mailing Address - Phone:860-532-3035
Mailing Address - Fax:
Practice Address - Street 1:58 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2625
Practice Address - Country:US
Practice Address - Phone:860-532-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002030376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker