Provider Demographics
NPI:1700897576
Name:RODRIGUEZ, M DAVID (NP)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:DAVID
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8335 FAIRMOUNT DR
Mailing Address - Street 2:#2-105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1130
Mailing Address - Country:US
Mailing Address - Phone:720-532-0305
Mailing Address - Fax:
Practice Address - Street 1:8335 FAIRMOUNT DR
Practice Address - Street 2:#2-105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1130
Practice Address - Country:US
Practice Address - Phone:720-532-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99992363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23605553Medicaid
COCO300023Medicare UPIN
CO452998Medicare ID - Type Unspecified
CO23605553Medicaid
COCO300023Medicare PIN
COP58283Medicare UPIN