Provider Demographics
NPI:1861299950
Name:RODRIGUEZ, MAIRA ALEJANDRA
Entity type:Individual
Prefix:
First Name:MAIRA
Middle Name:ALEJANDRA
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 1:1501 WINDY LN
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-5251
Mailing Address - Country:US
Mailing Address - Phone:951-250-0463
Mailing Address - Fax:
Practice Address - Street 1:4760 PAHRUMP VALLEY BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-1474
Practice Address - Country:US
Practice Address - Phone:951-250-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant