Provider Demographics
NPI:1437339512
Name:LEONEL G. RODARTE M.D.
Entity Type:Organization
Organization Name:LEONEL G. RODARTE M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-522-5111
Mailing Address - Street 1:3885 FOOTHILLS
Mailing Address - Street 2:STE. B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-522-5111
Mailing Address - Fax:575-522-5115
Practice Address - Street 1:3885 FOOTHILLS
Practice Address - Street 2:STE. B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-522-5111
Practice Address - Fax:575-522-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0380174400000X
NMNM2002-03802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32274050Medicaid
NM32274050Medicaid
NM34527801Medicare PIN
NM900521242Medicare PIN