Provider Demographics
NPI:1295590800
Name:RODRIQUEZ, YESENIA A (CRM, THW)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:A
Last Name:RODRIQUEZ
Suffix:
Gender:F
Credentials:CRM, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 CITY VIEW ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3325
Mailing Address - Country:US
Mailing Address - Phone:503-569-1219
Mailing Address - Fax:
Practice Address - Street 1:3886 BEVERLY AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1373
Practice Address - Country:US
Practice Address - Phone:541-521-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist