1235419474 NPI number — MR. PETER AIRTH RODRIGUEZ RN, BSN

Table of content: MR. PETER AIRTH RODRIGUEZ RN, BSN (NPI 1235419474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235419474 NPI number — MR. PETER AIRTH RODRIGUEZ RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
PETER
Provider Middle Name:
AIRTH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODRIGUEZ
Provider Other First Name:
PETER
Provider Other Middle Name:
ABIMAEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235419474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10065 E HARVARD AVE
Provider Second Line Business Mailing Address:
STE400
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-593-0896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10065 E HARVARD AVE
Provider Second Line Business Practice Location Address:
STE400
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-614-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2011

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: 163W00000X , with the licence number:  201028 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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