Provider Demographics
NPI:1609492743
Name:RODRIGUEZ, ALBERTO AGUILAR (NIM TECH)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:AGUILAR
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NIM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21012 S 194TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8804
Mailing Address - Country:US
Mailing Address - Phone:623-293-0658
Mailing Address - Fax:
Practice Address - Street 1:21012 S 194TH ST
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8804
Practice Address - Country:US
Practice Address - Phone:623-293-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic