Active NPI
Marilyn Rodriguez-Fernandini, DDS
- General Practice Dentistry
- Vancouver, WA
National Provider Identifier
1891871349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE00008203
- Practice address
- 1412 NE 88TH St
Vancouver, WA 98665-9620 - Phone
- (360) 574-4074
- Fax
- (360) 574-9237
- NPI assigned
- Oct 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00008203 | WA | Primary |
Addresses
Primary practice location
1412 NE 88TH St
Vancouver, WA 98665-9620
Mailing address
PO Box 34703
Seattle, WA 98124-1703
Phone (206) 764-0112
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5029939 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00008203 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sea Mar Community Health Centers | Past | Accepting new patients | |
| Sea Mar Community Health Centers | Past | Accepting new patients |
Interoperability endpoints
- mrodriguezfernandini452851@direct.multicare.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Vancouver, WA
- NPI 1912055138
-
- Federally Qualified Health Center (FQHC)
- Spanaway, WA
- NPI 1922624642
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1891871349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 34703",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981241703",
"telephone_number": "206-764-0112",
"fax_number": "206-764-0489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 NE 88TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986659620",
"telephone_number": "360-574-4074",
"fax_number": "360-574-9237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ-FERNANDINI",
"first_name": "MARILYN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00008203",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5029939",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.