Provider Demographics
NPI:1578131116
Name:RODRIGUEZ, CRUISE A (CPSW)
Entity Type:Individual
Prefix:
First Name:CRUISE
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 N GRANT ST STE A
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5134
Mailing Address - Country:US
Mailing Address - Phone:575-388-1447
Mailing Address - Fax:575-388-1447
Practice Address - Street 1:603 HADECO DR
Practice Address - Street 2:
Practice Address - City:LORDSBURG
Practice Address - State:NM
Practice Address - Zip Code:88045-1834
Practice Address - Country:US
Practice Address - Phone:575-542-8447
Practice Address - Fax:575-542-8447
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1146175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist