Provider Demographics
NPI:1336965482
Name:RODRIGUEZ PENA, LUZ D (FNP)
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:D
Last Name:RODRIGUEZ PENA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:D
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:978 POTTER AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7622
Mailing Address - Country:US
Mailing Address - Phone:973-699-5452
Mailing Address - Fax:
Practice Address - Street 1:978 POTTER AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7622
Practice Address - Country:US
Practice Address - Phone:973-699-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15214400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily