Provider Demographics
NPI:1568451839
Name:RODRIGUEZ, MONICA C (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:C
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W THOMAS RD # 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4407
Mailing Address - Country:US
Mailing Address - Phone:602-406-2748
Mailing Address - Fax:602-406-2770
Practice Address - Street 1:240 W THOMAS RD # 404
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4407
Practice Address - Country:US
Practice Address - Phone:602-406-2748
Practice Address - Fax:602-406-2770
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4402207RE0101X
AZ47578207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ831991Medicaid
AZ831991Medicaid
WAP00848595OtherRRMC
AR5N348Medicare ID - Type Unspecified
OK200060260AMedicaid
WA8889070Medicare PIN
WA8888439Medicare PIN
WA8888440OtherMEDICA PTAN - SNO CO
ARI42029Medicare UPIN