Provider Demographics
NPI:1295156370
Name:RODRIGUEZ, DINA DENISE (DOM)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:DENISE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 HERITAGE WAY NE
Mailing Address - Street 2:APT. B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3225
Mailing Address - Country:US
Mailing Address - Phone:805-233-4998
Mailing Address - Fax:505-292-0555
Practice Address - Street 1:5200 EUBANK BLVD NE
Practice Address - Street 2:SUITE C-3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1759
Practice Address - Country:US
Practice Address - Phone:505-323-8100
Practice Address - Fax:505-292-0555
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2021-11-09
Deactivation Date:2021-09-20
Deactivation Code:
Reactivation Date:2021-11-09
Provider Licenses
StateLicense IDTaxonomies
NM1130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist