1578503140 NPI number — MRS. MARIA LOURDES MARTIREZ RODRIGUEZ NNP/APRN

Table of content: MRS. MARIA LOURDES MARTIREZ RODRIGUEZ NNP/APRN (NPI 1578503140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578503140 NPI number — MRS. MARIA LOURDES MARTIREZ RODRIGUEZ NNP/APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
MARIA LOURDES
Provider Middle Name:
MARTIREZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NNP/APRN
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:
1578503140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 EAST FORT PIERCE 12
Provider Second Line Business Mailing Address:
SPECTRUM HEALTHCARE RESOURCES
Provider Business Mailing Address City Name:
ST. GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
436-668-4854
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SPECTRUM HEALTHCARE RESOURCES
Provider Second Line Business Practice Location Address:
6760 CORPORATE DRIVE SUITE 220
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-288-8044
Provider Business Practice Location Address Fax Number:
719-598-7945
Provider Enumeration Date:
06/08/2006

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: 363LN0000X , with the licence number:  5977278-8900 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X , with the licence number: APN000967 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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