Provider Demographics
NPI:1205017100
Name:PENA, RODOLFO CESAR (PHD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:CESAR
Last Name:PENA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WALTER ST NE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2534
Mailing Address - Country:US
Mailing Address - Phone:505-262-3851
Mailing Address - Fax:505-262-7040
Practice Address - Street 1:500 WALTER ST NE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2534
Practice Address - Country:US
Practice Address - Phone:505-262-3851
Practice Address - Fax:505-262-7040
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006520183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy