Provider Demographics
NPI:1538272364
Name:RODRIGUEZ, CARMEN ROMELIA (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROMELIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 QUINCY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6326
Mailing Address - Country:US
Mailing Address - Phone:505-266-4790
Mailing Address - Fax:505-262-6400
Practice Address - Street 1:500 SAN MATEO NE SUITE B
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-262-6500
Practice Address - Fax:505-262-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM88-64207Q00000X
TXJ1025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00016360Medicaid
NME14180Medicare UPIN
NM331331104Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NM00016360Medicaid
E14180Medicare UPIN