Provider Demographics
NPI:1053172973
Name:RODRIGUEZ, GIOVANNA FERNANDA (RDN)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:FERNANDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-2629
Mailing Address - Country:US
Mailing Address - Phone:203-829-0024
Mailing Address - Fax:
Practice Address - Street 1:126 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-2629
Practice Address - Country:US
Practice Address - Phone:203-829-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03036820002356133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered