Provider Demographics
NPI:1154598704
Name:RODRIGUEZ, MARIA ELENA (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:
Practice Address - Street 1:650 N FULTON ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3404
Practice Address - Country:US
Practice Address - Phone:559-488-4900
Practice Address - Fax:559-488-4999
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN415092363LC1500X
CA12164363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21572ZOtherGRP PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER MULT LOCATIONS
CAGR0043790Medicaid