Provider Demographics
NPI:1194367862
Name:PEREZ-RESENDIZ, RODRIGO (PA-C)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:PEREZ-RESENDIZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 SANDOVAL RD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7320
Mailing Address - Country:US
Mailing Address - Phone:505-865-3373
Mailing Address - Fax:
Practice Address - Street 1:127 SANDOVAL RD SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7320
Practice Address - Country:US
Practice Address - Phone:505-865-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1194827535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine