Provider Demographics
NPI:1942027792
Name:QUIZHPILEMA RODRIGUEZ, MIRIAM AZUCENA
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:AZUCENA
Last Name:QUIZHPILEMA 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 1:3711 SW DURHAM DR APT 208
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3334
Mailing Address - Country:US
Mailing Address - Phone:919-519-7041
Mailing Address - Fax:
Practice Address - Street 1:3711 SW DURHAM DR APT 208
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3334
Practice Address - Country:US
Practice Address - Phone:919-519-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC317800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health