Provider Demographics
NPI:1851839039
Name:ADAME-BEJARANO, RODRIGO
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:ADAME-BEJARANO
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 1:5250 S RAINBOW BLVD UNIT 2170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0954
Mailing Address - Country:US
Mailing Address - Phone:702-945-8050
Mailing Address - Fax:
Practice Address - Street 1:5250 S RAINBOW BLVD UNIT 2170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0954
Practice Address - Country:US
Practice Address - Phone:702-945-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker