1518000975 NPI number — MARISSA S RODRIGUEZ RPH, PHC

Table of content: MARISSA S RODRIGUEZ RPH, PHC (NPI 1518000975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518000975 NPI number — MARISSA S RODRIGUEZ RPH, PHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
MARISSA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH, PHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518000975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12405 RAINIER WAY NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87111-7272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-296-2549
Provider Business Mailing Address Fax Number:
505-291-2233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8300 CONSTITUTION AVE NE BLDG D
Provider Second Line Business Practice Location Address:
PRESBYTERIAN MEDICAL GROUP
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-7613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-291-2200
Provider Business Practice Location Address Fax Number:
505-291-2233
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5808 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC00000088 . This is a "PHARMACIST CLINICIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: RP00005808 . This is a "REGISTERED PHARMACIST" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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