Provider Demographics
NPI:1457602310
Name:RODRIGUEZ, KRISTYNNE L
Entity type:Individual
Prefix:
First Name:KRISTYNNE
Middle Name:L
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 1:5642 DARIEN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2315
Mailing Address - Country:US
Mailing Address - Phone:909-767-0951
Mailing Address - Fax:
Practice Address - Street 1:5642 DARIEN CT
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-2315
Practice Address - Country:US
Practice Address - Phone:909-767-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-1946482Medicaid