Provider Demographics
NPI:1316637432
Name:RODRIGUEZ, MARIANA GRACIELA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:GRACIELA
Last Name:RODRIGUEZ
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 1:1112 N ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3239
Mailing Address - Country:US
Mailing Address - Phone:559-260-3888
Mailing Address - Fax:
Practice Address - Street 1:1210 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3606
Practice Address - Country:US
Practice Address - Phone:559-445-0694
Practice Address - Fax:559-445-1480
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician