Basic Information
| Provider Information | |||||||||
| NPI: | 1669086641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | FRANCISCO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 819 DAISY CIR NE | ||||||||
| Address2: | |||||||||
| City: | DEMOTTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463109122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197071434 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872164 | ||||||||
| FaxNumber: | 2069872246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2020 | ||||||||
| LastUpdateDate: | 09/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP61096819 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.