Provider Demographics
NPI:1598512378
Name:RODRIGUEZ, VIVIAN IRENE
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:IRENE
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 1:1886 EAGLE HAMMOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33839-5704
Mailing Address - Country:US
Mailing Address - Phone:939-217-9142
Mailing Address - Fax:
Practice Address - Street 1:110 E OAK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2210
Practice Address - Country:US
Practice Address - Phone:813-224-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator