Provider Demographics
NPI:1780133454
Name:RODRIGUEZ, ELIZA
Entity type:Individual
Prefix:
First Name:ELIZA
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 1:2001 STORY AVE
Mailing Address - Street 2:8 B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2056
Mailing Address - Country:US
Mailing Address - Phone:917-544-7240
Mailing Address - Fax:
Practice Address - Street 1:2001 STORY AVE
Practice Address - Street 2:8 B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2056
Practice Address - Country:US
Practice Address - Phone:917-544-7240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580604163W00000X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine