Individual
ITZAYANA RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5037 CAROL CT, ROCKFORD, IL 61108-4157
(815) 601-1011
Mailing address
5037 CAROL CT, ROCKFORD, IL 61108-4157
(815) 601-1011
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
R362-4120-0822
IL
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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