Provider Demographics
NPI:1396332912
Name:RODRIGUEZ, BRENDA KAY
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
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 1:680 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9267
Mailing Address - Country:US
Mailing Address - Phone:419-822-6081
Mailing Address - Fax:
Practice Address - Street 1:680 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9267
Practice Address - Country:US
Practice Address - Phone:419-822-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare