Provider Demographics
NPI:1194009084
Name:ADAMS, RODERICK ANTHONY
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:ANTHONY
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E TWAIN AVE
Mailing Address - Street 2:92
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-4904
Mailing Address - Country:US
Mailing Address - Phone:702-378-7785
Mailing Address - Fax:
Practice Address - Street 1:450 E TWAIN AVE
Practice Address - Street 2:92
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-4904
Practice Address - Country:US
Practice Address - Phone:702-378-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker