Provider Demographics
NPI:1871613331
Name:RODRIGUES, LAURENTINA MARIE (RDMS, RT)
Entity type:Individual
Prefix:MS
First Name:LAURENTINA
Middle Name:MARIE
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:RDMS, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21945 HESS LN
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-9329
Mailing Address - Country:US
Mailing Address - Phone:951-928-2464
Mailing Address - Fax:
Practice Address - Street 1:21945 HESS LN
Practice Address - Street 2:
Practice Address - City:NUEVO
Practice Address - State:CA
Practice Address - Zip Code:92567-9329
Practice Address - Country:US
Practice Address - Phone:951-928-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1799182471C3402X
CA187152471S1302X
CA2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography