Provider Demographics
NPI:1881139095
Name:RODRIGUEZ, VIRGINIE
Entity type:Individual
Prefix:
First Name:VIRGINIE
Middle Name:
Last Name:RODRIGUEZ
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 1:502 COLLEGE ST APT B
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6941
Mailing Address - Country:US
Mailing Address - Phone:580-665-7242
Mailing Address - Fax:
Practice Address - Street 1:502 COLLEGE ST APT B
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6941
Practice Address - Country:US
Practice Address - Phone:580-665-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator