Provider Demographics
NPI:1366946915
Name:RODRIGUEZ, EDWIN JAVIER
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:JAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 COVE ROAD PENNSUAKEN
Mailing Address - Street 2:
Mailing Address - City:PENNSUAKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110
Mailing Address - Country:US
Mailing Address - Phone:787-515-3601
Mailing Address - Fax:
Practice Address - Street 1:2136 COVE ROAD PENNSUAKEN
Practice Address - Street 2:
Practice Address - City:PENNSUAKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-0811
Practice Address - Country:US
Practice Address - Phone:787-515-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82461G163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse