Provider Demographics
NPI:1891216040
Name:CORUGEDO, ROCHELLE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:MARIE
Last Name:CORUGEDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ROCHELLE
Other - Middle Name:MARIE
Other - Last Name:REDONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:38350 40TH ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3075
Mailing Address - Country:US
Mailing Address - Phone:661-225-3001
Mailing Address - Fax:
Practice Address - Street 1:38350 40TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3075
Practice Address - Country:US
Practice Address - Phone:661-225-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA522107163WP2201X, 171M00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522107OtherRN LICENSE