Provider Demographics
NPI:1215733704
Name:RODRIGUEZ GRASS, MILAGRO DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:MILAGRO
Middle Name:DE LA CARIDAD
Last Name:RODRIGUEZ GRASS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 E TIPPEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122
Mailing Address - Country:US
Mailing Address - Phone:562-482-2219
Mailing Address - Fax:702-995-0242
Practice Address - Street 1:2121 E FLAMINGO RD STE 212
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5124
Practice Address - Country:US
Practice Address - Phone:702-981-1484
Practice Address - Fax:702-995-0242
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider