Provider Demographics
NPI:1528706561
Name:RODRIGUEZ, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
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 1:3400 MCCALL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-2560
Mailing Address - Country:US
Mailing Address - Phone:855-343-1057
Mailing Address - Fax:844-566-2683
Practice Address - Street 1:3400 MCCALL AVE STE 104
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2560
Practice Address - Country:US
Practice Address - Phone:855-343-1057
Practice Address - Fax:844-566-2683
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist