Provider Demographics
NPI:1316725229
Name:RODRIGUEZ, MICHAELA ILIMA (CNA)
Entity type:Individual
Prefix:MRS
First Name:MICHAELA
Middle Name:ILIMA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21821
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-0967
Mailing Address - Country:US
Mailing Address - Phone:619-922-8473
Mailing Address - Fax:
Practice Address - Street 1:2660 ALPINE BLVD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3925
Practice Address - Country:US
Practice Address - Phone:619-922-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01228380376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide