Provider Demographics
NPI:1518774009
Name:RODILES, PRISCILLA LETAYF
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:LETAYF
Last Name:RODILES
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 1:1356 APPALOOSA RD
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9510
Mailing Address - Country:US
Mailing Address - Phone:619-710-6581
Mailing Address - Fax:
Practice Address - Street 1:1356 APPALOOSA RD
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9510
Practice Address - Country:US
Practice Address - Phone:619-710-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86008682133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered