Provider Demographics
NPI:1427176155
Name:RODRIGUEZ, LAIKA (ND)
Entity type:Individual
Prefix:MRS
First Name:LAIKA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:MRS
Other - First Name:LAIKA
Other - Middle Name:
Other - Last Name:RODRIGUEZ COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:1495 LIBERTY ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-364-5818
Mailing Address - Fax:503-364-2484
Practice Address - Street 1:1495 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-364-5818
Practice Address - Fax:503-364-2484
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1411175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath