Provider Demographics
NPI:1629870175
Name:RODRIGUEZ, VICTORIA K (OWNER)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:K
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455
Mailing Address - Country:US
Mailing Address - Phone:586-318-2978
Mailing Address - Fax:810-678-2766
Practice Address - Street 1:4554 THOMAS RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455
Practice Address - Country:US
Practice Address - Phone:586-318-2978
Practice Address - Fax:810-678-2766
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL440413121376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty