Provider Demographics
NPI:1558039420
Name:RODRIGUEZ, GUSTAVO ROCKY (NP-C)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ROCKY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3835
Mailing Address - Country:US
Mailing Address - Phone:505-277-0111
Mailing Address - Fax:
Practice Address - Street 1:1700 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3835
Practice Address - Country:US
Practice Address - Phone:505-277-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF08211209363LF0000X
NM65237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily