Provider Demographics
NPI:1619482437
Name:UGALDE, RODRIGO JOSE (CRNP)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:JOSE
Last Name:UGALDE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:JOSE
Other - Last Name:UGALDE-MAGNANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2112 HARRISBURG PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2112 HARRISBURG PIKE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily