Provider Demographics
NPI:1639943699
Name:RODRIGUEZ, SUZANNE ROSE (CPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ROSE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:MRS
Other - First Name:SUZANNE
Other - Middle Name:ROSE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPT
Mailing Address - Street 1:3040 RIO BRAVO BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-5532
Mailing Address - Country:US
Mailing Address - Phone:505-917-3963
Mailing Address - Fax:505-314-5443
Practice Address - Street 1:3040 RIO BRAVO BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-5532
Practice Address - Country:US
Practice Address - Phone:505-917-3963
Practice Address - Fax:505-314-5443
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1210728861171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach