Provider Demographics
NPI:1770221764
Name:RODRIGUEZ, MANUEL DAVID
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:DAVID
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27735 E MORAINE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-7325
Mailing Address - Country:US
Mailing Address - Phone:573-355-1088
Mailing Address - Fax:
Practice Address - Street 1:27735 E MORAINE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-7325
Practice Address - Country:US
Practice Address - Phone:573-355-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1753103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty