Provider Demographics
NPI:1528029980
Name:RODARTE, LEONEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONEL
Middle Name:G
Last Name:RODARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3885 FOOTHILLS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4672
Mailing Address - Country:US
Mailing Address - Phone:575-522-5111
Mailing Address - Fax:575-522-5115
Practice Address - Street 1:3885 FOOTHILLS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4672
Practice Address - Country:US
Practice Address - Phone:575-522-5111
Practice Address - Fax:575-522-5115
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2002-03802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32274050Medicaid
NM32274050Medicaid
NM34527801Medicare ID - Type Unspecified