Provider Demographics
NPI:1952736670
Name:RODRIQUEZ, ROCKY LUGO JR (MOTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROCKY
Middle Name:LUGO
Last Name:RODRIQUEZ
Suffix:JR
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 CAROL ANN WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-1051
Mailing Address - Country:US
Mailing Address - Phone:575-910-2251
Mailing Address - Fax:
Practice Address - Street 1:3511 CAROL ANN WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-1051
Practice Address - Country:US
Practice Address - Phone:575-910-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3008171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor