Provider Demographics
NPI:1700439882
Name:RODRIGUEZ, DEBORAH SUE (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 EL PASEO ST NW
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-1410
Mailing Address - Country:US
Mailing Address - Phone:925-413-9916
Mailing Address - Fax:
Practice Address - Street 1:5115 COORS BLVD NW STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1926
Practice Address - Country:US
Practice Address - Phone:505-897-6560
Practice Address - Fax:505-715-5537
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7866225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000OtherNONE