Provider Demographics
NPI:1285862698
Name:RODES, STUART (LAC)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:RODES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W DUVAL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614
Mailing Address - Country:US
Mailing Address - Phone:520-393-7734
Mailing Address - Fax:
Practice Address - Street 1:231 W DUVAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4313
Practice Address - Country:US
Practice Address - Phone:520-393-7734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist