Provider Demographics
NPI:1780080689
Name:VERDUGO, RUDOLPH MARTINEZ I (RESPIRATORY THERAPIS)
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:MARTINEZ
Last Name:VERDUGO
Suffix:I
Gender:M
Credentials:RESPIRATORY THERAPIS
Other - Prefix:MR
Other - First Name:RUDY
Other - Middle Name:MARTINEZ
Other - Last Name:VERDUGO
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RESPIRATORY THERAPIS
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE N12 &N7
Practice Address - Street 2:
Practice Address - City:FT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0019342278G1100X, 2278E0002X, 2278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
No2278E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEmergency Care