Provider Demographics
NPI:1669749552
Name:RODRIGUEZ, ANGELICA MARIA (AUD)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1000 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3038
Mailing Address - Country:US
Mailing Address - Phone:575-623-8474
Mailing Address - Fax:575-623-8220
Practice Address - Street 1:1000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3038
Practice Address - Country:US
Practice Address - Phone:575-623-8474
Practice Address - Fax:575-623-8220
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4960231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist