Provider Demographics
NPI:1720843220
Name:RODRIGUEZ, MIREYA
Entity type:Individual
Prefix:MRS
First Name:MIREYA
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 1:251 E AVENUE K6 STE H
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4513
Mailing Address - Country:US
Mailing Address - Phone:661-974-8400
Mailing Address - Fax:
Practice Address - Street 1:251 E AVENUE K6 STE H
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4513
Practice Address - Country:US
Practice Address - Phone:661-463-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker