Individual
JACOB RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
428 E 25TH ST, BALTIMORE, MD 21218-5304
(410) 617-0142
Mailing address
7257 STEAMERBELL ROW, COLUMBIA, MD 21045
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R239870
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R239870
MARYLAND STATE BOARD OF NURSING
MD
Enumeration date
08/21/2019
Last updated
07/29/2020
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