Basic Information
| Provider Information | |||||||||
| NPI: | 1851041644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LIMAYRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 BROKEN TWIG CT | ||||||||
| Address2: | |||||||||
| City: | N LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890320704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029342721 | ||||||||
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| Practice Location | |||||||||
| Address1: | 703 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PATERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 075032621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777577547 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2022 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.