Provider Demographics
NPI:1114744422
Name:RODRIGUEZ, JASMINE RIVERA (OD, MPH)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:RIVERA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 E INDIAN SCHOOL RD APT 304
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5455
Mailing Address - Country:US
Mailing Address - Phone:253-224-4649
Mailing Address - Fax:
Practice Address - Street 1:4502 E INDIAN SCHOOL RD APT 304
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5455
Practice Address - Country:US
Practice Address - Phone:253-224-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist